New views on pathophysiology, diagnostics and treatment of heart failure with preserved ejection fraction
Abstract
Heart failure with preserved ejection fraction (HFpEF) is associated with significant morbidity and mortality and accounts for approximately one half of all patients with chronic heart failure. It is characterised by a complex pathophysiology, including multiple aetiologic mechanisms, and is accompanied by a broad spectrum of comorbidities in addition to a whole range of clinical manifestations.
Proven therapies other than diuretics are lacking. The failure to develop successful therapies for the management of HFpEF may be explained by an overly broad definition of the disease and inadequate differentiation of its subtypes.
Progress in the understanding of complicated pathophysiology is leading to the testing of new therapies directed at improving the symptoms as well as survival. Clinical trials are more targeted at specific subgroups or specific phases of this clinical syndrome.
An example is the testing of heart rate slowing by ivabradine. The PARAGON-HF clinical trial is now testing the very promising dual humoral inhibition of RAAS and neprilysin by drug LCZ696.
Different non-pharmacological therapies are also tested in smaller trials.