ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology
Heart failure with non-reduced ejection fraction: Epidemiology, Pathophysiology, Phenotypes, Diagnosis and Treatment Approaches [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2022; 50(1): 1-34 | DOI: 10.5543/tkda.2022.S1

Heart failure with non-reduced ejection fraction: Epidemiology, Pathophysiology, Phenotypes, Diagnosis and Treatment Approaches

Yüksel Çavuşoğlu1, Ahmet Çelik2, Hakan Altay3, Sanem Nalbantgil4, Özge Özden5, Ahmet Temizhan6, Dilek Ural7, Serkan Ünlü8, Mehmet Birhan Yılmaz9, Mehdi Zoghi4
1Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Eskişehir
2Mersin Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Mersin
3Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul
4Ege Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, İzmir
5Memorial Bahçelievler Hastanesi, Kardiyoloji Kliniği, İstanbul
6Sağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Anabilim Dalı, Ankara
7Koç Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul
8Gazi Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Ankara
9Dokuz Eylül Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, İzmir

Heart failure (HF) has been classified as reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) by the recent HF guidelines. In addition, HF with improved ejection fraction has been defined as a subgroup of HFrEF. In HFrEF, diagnostic workup and evidence-based pharmacological and device-based therapies have been well established. However, HFpEF, which comprises almost half of the HF population, represents significant uncertainties regarding its pathophysiology, clinical phenotypes, diagnosis and treatment. Diagnostic criteria of HFpEF have been changed a few times over the years and still remained a matter of debate. New paradigms including a prominent role of co-morbidities, inflammation, endothelial dysfunction have been proposed in its pathophysiology. As a complex, multifactorial syndrome HFpEF consists of many overlapping clinical and hemodynamic phenotypes. In contrast to HFrEF, clinical outcomes of HFpEF have not improved over the last decades due to lack of proven effective therapies. Although HFrEF and HFpEF have different clinical spectrums and proposed pathophysiological mechanisms, there is no clear defining syndrome postulated for HFmrEF. Clinical characteristics and risk factors of HFm-rEF overlap with HFrEF and HFpEF. HFmrEF is also referred as a transitional zone for dynamic temporal changes in EF. So, HFpEF and HFmrEF, both namely HF with non-reduced ejection fraction (HF-NEF), have some challenges in the management of HF. The purpose of this paper is to provide a comprehensive review including epidemiology, pathophysiology, clinical presentation and phenotypes of HF-NEF and to guide clinicians for the diagnosis and therapeutic approaches based on the available data in the literature.

Keywords: Heart failure with preserved ejection fraction, diagnosis, therapy

How to cite this article
Yüksel Çavuşoğlu, Ahmet Çelik, Hakan Altay, Sanem Nalbantgil, Özge Özden, Ahmet Temizhan, Dilek Ural, Serkan Ünlü, Mehmet Birhan Yılmaz, Mehdi Zoghi. Heart failure with non-reduced ejection fraction: Epidemiology, Pathophysiology, Phenotypes, Diagnosis and Treatment Approaches. Turk Kardiyol Dern Ars. 2022; 50(1): 1-34

Corresponding Author: Yüksel Çavuşoğlu
Manuscript Language: Turkish


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