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Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; [1] this may be measured by echocardiography or cardiac catheterization.
An ejection fraction (EF) is the volumetric fraction (or portion of the total) of fluid (usually blood) ejected from a chamber (usually the heart) with each contraction (or heartbeat). It can refer to the cardiac atrium , [ 1 ] ventricle , [ 2 ] gall bladder, [ 3 ] or leg veins, [ 4 ] although if unspecified it usually refers to the left ...
Left-sided heart failure may be present with a reduced ejection fraction or with a preserved ejection fraction. [10] Heart failure is not the same as cardiac arrest, in which blood flow stops completely due to the failure of the heart to pump. [12] [13] Diagnosis is based on symptoms, physical findings, and echocardiography. [6]
It’s possible to have heart failure even when your ejection fraction falls in the normal range. This is known as heart failure with preserved ejection fraction (HFpEF). Congenital heart disease
This is defined as a left ventricular ejection fraction (LVEF) of 40% or less. About half of heart failure patients have a reduced ejection fraction. [2] Other types of heart failure are heart failure with mildly reduced ejection fraction (LVEF between 40% and 50%) and heart failure with preserved ejection fraction (LVEF 50% or higher). [1] [3]
The preferred term is now heart failure with normal ejection fraction (HFNEF) or heart failure with preserved ejection fraction (HFPEF). This is common and is often seen in hypertensive heart disease, hypertrophic cardiomyopathy and aortic stenosis, and may comprise as much as 50% of the total heart failure population. [22]
Armstrong PW, Butler J et al. "Effect of Vericiguat vs Placebo on Quality of Life in Patients with Heart Failure and Preserved Ejection Fraction: The VITALITY-HFpEF Randomized Clinical Trial." JAMA 2020. Butler J et al. "Redefining Heart Failure with a Reduced Ejection Fraction." JAMA 2019.
Before progression to a dilated phenotype, mechanical obstruction of the outflow tract can occur, leading to reduced cardiac output. Additionally, increased fibrosis of the ventricle can result in a failure to relax appropriately which impairs cardiac filling and may lead to diastolic dysfunction or heart failure with preserved ejection fraction.
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