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The pathophysiology of heart failure with preserved ejection fraction (HFPEF) is driven by interactions among age-dependent and gender-dependent characteristics of ventricular-arterial coupling and various predisposing comorbidities and risk factors.
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Ventricular diastolic dysfunction is central in the pathogenesis of HFPEF caused by an increased ventricular stiffness and is responsible for limited exercise tolerance.
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At tissue, cellular, and molecular levels, concentric myocardial hypertrophy,
Causes and Pathophysiology of Heart Failure with Preserved Ejection Fraction
Section snippets
Key points
Interaction Between the Heart and Vasculature Is the Achilles Heel of the Cardiovascular System
HFPEF is increasingly recognized as a disease of abnormal ventricular-arterial coupling in association with decreased exercise tolerance.9 To understand the main pathologic pathways leading to this exercise intolerance, basic issues of hemodynamic coupling between the heart and the vasculature should be reviewed under physiologic and pathologic conditions.
The term of ventricular-arterial coupling refers to an interaction between the heart and the vascular system, because the stroke volume (SV)
Risk factors and comorbidities as triggers in HFPEF
Comorbidities have major influence on the pathogenesis of HFPEF. In addition to the primary age-dependent derangements between the myocardium and the vascular system,18 various comorbidities may evoke additional adverse effects on ventricular and vascular functions45 (Fig. 2). Moreover, the prognosis of HFPEF with comorbidities is worse than can be expected with comorbidities alone.46
Because multiple comorbidities influence the prognosis of HFPEF, their targeted treatment takes priority and may
Cellular and molecular mechanisms of increased stiffness: translation of comorbidities to pathophysiology
Myocardial remodeling in HFPEF differs from that in HFREF, in which myocardial remodeling is dominated by cardiomyocyte loss.50 In contrast, in HFPEF, numerous comorbidities result in cellular and molecular changes that promote cardiac and vascular stiffening and contribute to LV diastolic dysfunction (Fig. 3).
Summary
The pathophysiology of HFPEF is driven by interactions among age-dependent and gender-dependent characteristics of ventricular-arterial coupling and various predisposing comorbidities and risk factors. Ventricular diastolic dysfunction is central in the pathogenesis of HFPEF as a result of increased ventricular stiffness and it is responsible for limited exercise tolerance. At tissue, cellular, and molecular levels, concentric myocardial hypertrophy, alterations in ECM and fibrosis,
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Cited by (21)
Clinical Phenotypes of Heart Failure With Preserved Ejection Fraction to Select Preclinical Animal Models
2022, JACC: Basic to Translational SciencePerioperative Hypertension and Diastolic Dysfunction
2017, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :An observational study exploring the link between systemic hypertension and acute pulmonary edema confirmed that the latter is due to exacerbated diastolic dysfunction and not because of systolic abnormalities.21 The link between the stated benign perioperative risks of systemic hypertension and the ominous diagnosis of pulmonary edema is via diastolic heart dysfunction.22 This singular risk of systemic hypertension in the perioperative period as causative in overt heart failure (secondary to altered loading conditions) could lead to a reassessment of its risk in a given patient.
What is the association between left ventricular diastolic dysfunction and 6-minute walk test in hypertensive patients?
2017, Journal of the American Society of HypertensionCitation Excerpt :LV diastolic dysfunction and LVH have been identified as the main myocardial functional and structural abnormalities by which hypertensive heart disease and HFpEF develop in hypertensive patients.20 In spite of preserved EF in HFpEF, patients with HFpEF have some degree of LV systolic dysfunction that is not reflected by the EF21 but could be detected in these patients by measuring the impaired midwall fractional shortening22 or the impaired regional strain, as quantified by speckle tracking echocardiography.23 LV diastolic dysfunction is evident in hypertensive patients even before the appearance of symptoms.
Left atrial ejection force as a marker for the diagnosis of heart failure with preserved ejection fraction
2021, Journal of Cardiovascular EchographyLeft ventricular remodeling shortly after open mitral valve replacement for rheumatic mitral stenosis
2021, Brazilian Journal of Cardiovascular Surgery
This work was supported by the Social Renewal Operational Programme [TÁMOP-4.2.2.A-11/1/KONV-2012-0045], by a Hungarian Scientific Research Fund [OTKA K 109083], and by the European Union Project FP7-HEALTH-2010: “MEDIA-Metabolic Road to Diastolic Heart Failure” MEDIA-261409.
The authors have nothing to disclose.