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Heart Failure with Normal Ejection Fraction

Pathophysiology, Diagnosis, and Treatment

Herzinsuffizienz mit normaler Ejektionsfraktion. Pathophysiologie, Diagnose und Behandlung

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Abstract

Symptoms of heart failure are documented in patients, in a manner independent of their current ejection fraction (EF). Today, about 50% of all heart failure patients have a normal EF (HFNEF) and their outcome regarding mortality and morbidity is as severe as in patients with reduced EF. Nevertheless, the awareness of this disease is still limited. Furthermore, the diagnostic criteria are still a challenge in the daily clinical setting. Here, the recent recommendations of the European Society of Cardiology (ESC) on how to diagnose HFNEF will be reviewed. Moreover, the recent pathologic understanding will be discussed as well, because alongside noncardiac reasons for HFNEF, diastolic as well as nondiastolic abnormalities are known to be important for the development of HFNEF. Treatment options will be reviewed including the recent clinical trials for this group of patients.

Zusammenfassung

Symptome der Herzinsuffizienz finden sich bei Patienten unabhängig von der Ejektionsfraktion (EF). Neuere Untersuchungen zeigen, dass etwa 50% aller herzinsuffizienten Patienten eine normale EF > 50% haben (HFNEF). Die Mortalität und Morbidität der Patienten sind der Prognose der Patienten mit eingeschränkter EF vergleichbar. Trotzdem ist der Bekanntheitsgrad der Erkrankung immer noch begrenzt, und im klinischen Alltag ist die Diagnosestellung schwierig. Im vorliegenden Beitrag werden die Empfehlungen der European Society of Cardiology (ESC) in diesem Zusammenhang aufgegriffen und erläutert. Zusätzlich werden diskutierte kardiale und nichtkardiale Mechanismen bei der Entstehung von HFNEF vorgestellt. Abschließend wird die Studienlage zur Therapie kritisch zusammengefasst.

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Authors and Affiliations

  1. Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Berlin, Germany

    Dirk Westermann

  2. Department of Cardiology and Pneumology, Benjamin Franklin Campus, Charité University Hospital, Hindenburgdamm 30, 12200, Berlin, Germany

    Carsten Tschöpe MD

Authors
  1. Carsten Tschöpe MD
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  2. Dirk Westermann
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Correspondence to Carsten Tschöpe MD.

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Tschöpe, C., Westermann, D. Heart Failure with Normal Ejection Fraction. Herz 34, 89–96 (2009). https://doi.org/10.1007/s00059-009-3197-6

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  • DOI: https://doi.org/10.1007/s00059-009-3197-6

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