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Perspective

Emerging therapies for heart failure with preserved ejection fraction

Shane Nanayakkara, JUSTIN A. MARIANI, DAVID M. KAYE

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Abstract

Despite significant advances in treatment for both coronary artery disease and systolic heart failure, there are no therapies that have yet been developed to reduce mortality or to consistently relieve symptoms in patients with heart failure with preserved ejection fraction.

Key Points

  • Heart failure with preserved ejection fraction (HFpEF) is projected to become more prevalent than heart failure with reduced ejection fraction (HFrEF) over the coming years.
  • Exercise stress assessment of diastolic function, particularly by right heart catheterisation, is emerging as the gold standard test in the diagnosis of HFpEF. Right heart catheterisation can confirm the diagnosis and also assist in dose-titration of diuretic and other medical therapy.
  • Current evidence-based therapies for heart failure with reduced ejection fraction have been trialled in patients HFpEF with limited success.
  • Promising novel treatments include newer pharmacological therapy and inter-atrial shunt device implantation.
  • Current management is focused on lifestyle modification (weight loss and exercise), blood pressure control, judicious use of diuretics to maintain fluid balance and management of comorbidities such as atrial fibrillation. Presently, prescribed exercise training and weight loss are the most effective disease-modifying therapies.

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