Author + information
- Received September 7, 2018
- Revision received December 6, 2018
- Accepted December 7, 2018
- Published online January 6, 2020.
- Masaru Obokata, MD, PhD,
- Yogesh N.V. Reddy, MBBS, MSc and
- Barry A. Borlaug, MD∗ ()
- ↵∗Address for correspondence:
Dr. Barry A. Borlaug, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, Minnesota 55905.
• HFpEF is a heterogeneous syndrome, and categorizing patients based upon pathophysiology may provide phenotype-specific therapies.
• Echocardiography provides valuable information for assessing pathophysiological mechanisms, phenotyping, and diagnosis in cases of HFpEF.
• Further study is needed to establish the HFpEF phenotype and roles of noninvasive imaging in it.
Research in the last decade has substantially advanced our understanding of the pathophysiology of heart failure with preserved ejection fraction (HFpEF). However, treatment options remain limited as clinical trials have largely failed to identify effective therapies. Part of this failure may be related to mechanistic heterogeneity. It is speculated that categorizing HFpEF patients based upon underlying pathophysiological phenotypes may represent the key next step in delivering the right therapies to the right patients. Echocardiography may provide valuable insight into both the pathophysiology and underlying phenotypes in HFpEF. Echocardiography also plays a key role in the evaluation of patients with unexplained dyspnea, where HFpEF is suspected but the diagnosis remains unknown. The combination of the E/e′ ratio and right ventricular systolic pressure has recently been shown to add independent value to the diagnostic evaluation of patients suspected of having HFpEF. Finally, echocardiography enables identification of the different causes that mimic HFpEF but are treated differently, such as valvular heart disease, pericardial constriction, and high-output heart failure or infiltrative myopathies such as cardiac amyloid. This review summarizes the current understanding of the pathophysiology and phenotyping of HFpEF with particular attention to the role of echocardiography in this context.
Dr. Borlaug is supported by U.S. National Institutes of Health grants R01 HL128526, R01 HL 126638, U01 HL125205, and U10 HL110262. Dr. Obokata is supported by a research fellowship from the Uehara Memorial Foundation, Japan. Dr. Reddy has reported that he has no relationships relevant to the contents of this paper to disclose. Sherif Nagueh, MD, served as Guest Editor for this paper.
- Received September 7, 2018.
- Revision received December 6, 2018.
- Accepted December 7, 2018.
- 2020 American College of Cardiology Foundation
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