Heart Failure with Preserved Ejection Fraction (HFpEF): A Case Report
Abstract
Background: The prevalence of Heart Failure with Preserved Ejection Fraction (HFpEF) currently reaches 50% of heart failure cases and continues to increase every year. HFpEF is an important clinical condition, but the diagnosis is far more challenging than HFrEF (Heart Failure with Reduced Ejection Fraction), and there has not been any proven effective treatment. In this case presentation, the latest HFpEF diagnosis and therapy will be discussed.
Case illustration and discussion: A man and a woman came to the emergency room with signs and symptoms of congestion suggestive of heart failure. Additional examination was performed to support the working diagnosis of HFpEF, namely ECG, NTproBNP and echocardiography. HFA-PEFF scores of the first and second patient was 3 and 4 respectively. During hospitalization, diuretics was given to overcome congestion according to guidelines, as well as ACE-inhibitor and beta-blocker. Both patients were also screened for cardiovascular and non-cardiovascular comorbidities, and were given appropriate therapy.
Conclusion: The diagnosis of HFpEF does not have a gold standard yet, meanwhile, the HFA-PEFF scoring can be used. Recommended HFpEF therapy includes diuretics for congestion and management of comorbidities. Several studies of HFpEF treatment are ongoing.
Keywords: heart failure with preserved ejection fraction, HFpEF
Downloads
References
2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129-2200m.
3. Tromp J, Tay WT, Ouwerkerk W, Teng THK, Yap J, MacDonald MR, Leineweber K, McMurray JJV, Zile MR, Anand IS, Lam CSP. Multimorbidity in patients with heart failure from 11 Asian regions: A prospective cohort study using the ASIAN-HF registry. PLoS Med. 2018;15:1-22.
4. Lam CSP. What is normal in HFNEF?: The case for HFpEF. JACC Hear Fail. 2014;2:541-543.
5. Pieske B, Tschöpe C, De Boer RA, Fraser AG, Anker SD, Donal E, et al. How to diagnose heart failure with preserved ejection fraction: The HFA-PEFF diagnostic algorithm: A consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40:3297-3317.
6. Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, Testani JM, Tang WHW, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic PM, Ruschitzka F, Coats AJ. The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21:137-155.
7. Senni M, Paulus WJ, Gavazzi A, Fraser AG, Díez J, Solomon SD, et al. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes.
8. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359:2456-2467.
9. Cheng S, Fernandes VRS, Bluemke DA, McClelland RL, Kronmal RA, Lima JAC. Age-related left ventricular remodeling and associated risk for cardiovascular outcomes the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging. 2009;2:191-198.
10. Lam CSP, Carson PE, Anand IS, Rector TS, Kuskowski M, Komajda M, McKelvie RS, McMurray JJ, Zile MR, Massie BM, Kitzman DW. Sex differences in clinical characteristics and outcomes in elderly patients with heart failure and preserved ejection fraction: The Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial. Circ Hear Fail. 2012;5:571-578.
11. Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP, et al. Angiotensin–neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381:1609-1620.
PDF downloads: 1984
Copyright (c) 2021 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
