Current Heart Failure Reports

, Volume 11, Issue 4, pp 354–365 | Cite as

Epidemiology of Heart Failure with Preserved Ejection Fraction

  • Abhinav Dhingra
  • Aayushi Garg
  • Simrat Kaur
  • Saurav Chopra
  • Jaspreet Singh Batra
  • Ambarish Pandey
  • Antoine H. Chaanine
  • Sunil K. Agarwal
Prevention of Heart Failure (M St. John Sutton, Section Editor)


The prevalence of heart failure (HF) and its subtype, HF with preserved ejection fraction (HFpEF), is on the rise due to aging of the population. HFpEF is convergence of several pathophysiological processes, which are not yet clearly identified. HFpEF is usually seen in association with systemic diseases, such as diabetes, hypertension, atrial fibrillation, sleep apnea, renal and pulmonary disease. The proportion of HF patients with HFpEF varies by patient demographics, study settings (cohort vs. clinical trial, outpatient clinics vs. hospitalised patients) and cut points used to define preserved function. There is an expanding body of literature about prevalence and prognostic significance of both cardiovascular and non-cardiovascular comorbidities in HFpEF patients. Current therapeutic approaches are targeted towards alleviating the symptoms, treating the associated comorbid conditions, and reducing recurrent hospital admissions. There is lack of evidence-based therapies that show a reduction in the mortality amongst HFpEF patients; however, an improvement in exercise tolerance and quality of life is seen with few interventions. In this review, we highlight the epidemiology and current treatment options for HFpEF.


Diastolic heart failure Epidemiology Preserved ejection fraction Prevalence 


Compliance with Ethics Guidelines

Conflict of Interest

Abhinav Dhingra, Aayushi Garg, Simrat Kaur, Saurav Chopra, Jaspreet Singh Batra, Ambarish Pandey, Antoine H. Chaanine and Sunil K. Agarwal declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119:391–479.CrossRefGoogle Scholar
  2. 2.
    Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348:2007–18.PubMedCrossRefGoogle Scholar
  3. 3.
    Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001;38:2101–13.PubMedCrossRefGoogle Scholar
  4. 4.••
    Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–292. This AHA document highlights the statistics for HF epidemic in the US.PubMedCrossRefGoogle Scholar
  5. 5.
    McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Committee for Practice Guidelines. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847.PubMedCrossRefGoogle Scholar
  6. 6.••
    Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, et al. Outcome of heart failure with preserved ejection in a population-based study. N Engl J Med. 2006;355:260–9. This study reported similar one year mortality in patients with newly diagnosed HFpEF and HFrEF.PubMedCrossRefGoogle Scholar
  7. 7.••
    Zile MR, Gaasch WH, Anand IS, Haass M, Little WC, Miller AB, et al. Mode of death in patients with heart failure and a preserved ejection fraction: results from the Irbesartan in Heart Failure with Preserved Ejection Fraction Study (I-Preserve) trial. Circulation. 2010;121:1393–405. This study reports the causes of death among HFpEF patients enrolled in a large trial.PubMedCrossRefGoogle Scholar
  8. 8.
    Rosamond WD, Chang PP, Baggett C, Johnson A, Bertoni AG, Shahar E, et al. Classification of heart failure in the atherosclerosis risk in communities (ARIC) study: a comparison of diagnostic criteria. Circ Heart Fail. 2012;5(2):152–9.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.•
    Loehr LR, Agarwal SK, Baggett C, Wruck LM, Chang PP, Solomon SD, et al. Classification of acute decompensated heart failure: an automated algorithm compared with a physician reviewer panel: the Atherosclerosis Risk in Communities study. Circ Heart Fail. 2013;6(4):719–26. This study implements and compares a novel heart failure classification consensus scheme that includes biomarkers and echocardiographic parameters.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.••
    Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9. This study reported an increase in prevalence from 1987–2001 without any improvement in mortality rates in a US community with predominantly white patients.PubMedCrossRefGoogle Scholar
  11. 11.••
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey Jr DE, Drazner MH, et al. ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):1810–52. This AHA/ACC guideline highlights the management options and algorithms for HF patients.PubMedCrossRefGoogle Scholar
  12. 12.
    Maurer MS, Hummel SL. Heart failure with a preserved ejection fraction: what is in a name? J Am Coll Cardiol. 2011;58(3):275–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Bishu K, Deswal A, Chen HH, LeWinter MM, Lewis GD, Semigran MJ, et al. Biomarkers in acutely decompensated heart failure with preserved or reduced ejection fraction. Am Heart J. 2012;164(5):763–70.PubMedCrossRefGoogle Scholar
  14. 14.
    Penicka M, Vanderheyden M, Bartunek J. Diagnosis of heart failure with preserved ejection fraction: role of clinical Doppler echocardiography. Heart. 2014;100(1):68–76.PubMedCrossRefGoogle Scholar
  15. 15.•
    Dunlay SM, Roger VL, Weston SA, Jiang R, Redfield MM. Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction. Circ Heart Fail. 2012;5(6):720–6. This study reports changes in EF based status among HFpEF and HFrEF patients over time.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Punnoose LR, Givertz MM, Lewis EF, Pratibhu P, Stevenson LW, Desai AS. Heart failure with recovered ejection fraction: a distinct clinical entity. J Card Fail. 2011;17:527–32.PubMedCrossRefGoogle Scholar
  17. 17.
    Basuray A, French B, Ky B, Vorovich E, Olt C, Sweitzer NK, et al. Heart failure with recovered ejection fraction: clinical description, biomarkers, and outcomes. Circulation. 2014;129(23):2380–7. This study reports the prevalence of HF with recovered EF and distinguishes it from HFpEF and HFrEF.PubMedCrossRefGoogle Scholar
  18. 18.
    Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000;101:2118–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure—abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004;350:1953–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539–50.PubMedCrossRefGoogle Scholar
  21. 21.
    Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol. 1995;26:1565–74.PubMedCrossRefGoogle Scholar
  22. 22.••
    Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) database. J Am Coll Cardiol. 2006;47(1):76–84. A descriptive paper from largest registry of hospitalized HFpEF patients.PubMedCrossRefGoogle Scholar
  23. 23.
    Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50(8):768–77.PubMedCrossRefGoogle Scholar
  24. 24.
    Chang PP, Chambless LE, Shahar E, Bertoni AG, Russell SD, Ni H, et al. Incidence and survival of hospitalized acute decompensated heart failure in four US communities (from the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2014;113(3):504–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005;47:320–32.PubMedCrossRefGoogle Scholar
  26. 26.•
    Ceia F, Fonseca C, Mota T, Morais H, Matias F, de Sousa A, et al. Prevalence of chronic heart failure in Southwestern Europe: the EPICA study. Eur J Heart Fail. 2002;4:531–9. This study reports the prevalence of HFpEF in Portuguese reporting a higher prevalence than HFrEF.PubMedCrossRefGoogle Scholar
  27. 27.
    Curtis LH, Whellan DJ, Hammill BG, Hernandez AF, Anstrom KJ, Shea AM, et al. Incidence and prevalence of heart failure in elderly persons, 1994–2003. Arch Intern Med. 2008;168(4):418–24.PubMedCrossRefGoogle Scholar
  28. 28.•
    Levy D, Kenchaiah S, Larson MG, Benjamin EJ, Kupka MJ, Ho KK, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347:1397–402. This paper from Framingham cohort study reports a decrease in HF mortality since 1950, and a simultaneous decline in HF incidence among women but not among men.PubMedCrossRefGoogle Scholar
  29. 29.
    Senni M, Tribouilloy CM, Rodeheffer RJ, Jacobsen SJ, Evans JM, Bailey KR, et al. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998;98:2282–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Yip GW, Ho PP, Woo KS, Sanderson JE. Comparison of frequencies of left ventricular systolic and diastolic heart failure in Chinese living in Hong Kong. Am J Cardiol. 1999;84:563–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Sharp A, Tapp R, Francis DP, McG Thom SA, Hughes AD, Stanton AV, et al. Ethnicity and left ventricular diastolic function in hypertension an ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) substudy. J Am Coll Cardiol. 2008;52:1015–21.PubMedCrossRefGoogle Scholar
  32. 32.
    East MA, Peterson ED, Shaw LK, Gattis WA, O’Connor CM. Racial difference in the outcomes of patients with diastolic heart failure. Am Heart J. 2004;148:151–6. This study reports poorer survival among black patients with HFpEF than whites.PubMedCrossRefGoogle Scholar
  33. 33.
    MacCarthy PA, Kearney MT, Nolan J, Lee AJ, Prescott RJ, Shah AM, et al. Prognosis in heart failure with preserved left ventricular systolic function: prospective cohort study. BMJ. 2003;327:78–9.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Klapholz M, Maurer M, Lowe AM, Messineo F, Meisner JS, Mitchell J, et al. Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: results of the New York Heart Failure Registry. J Am Coll Cardiol. 2004;43:1432–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Hamaguchi S, Kinugawa S, Sobirin MA, Goto D, Tsuchihashi-Makaya M, Yamada S, et al. Mode of death in patients with heart failure and reduced vs. preserved ejection fraction: report from the registry of hospitalized heart failure patients. Circ J. 2012;76(7):1662–9.PubMedCrossRefGoogle Scholar
  36. 36.•
    Steinberg BA, Zhao X, Heidenreich PA, Peterson ED, Bhatt DL, Cannon CP, et al. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation. 2012;126(1):65–75. Study discussing in detail the hospitalization and in-hospital mortality in patients of Heart failure with Preserved ejection fraction.PubMedCrossRefGoogle Scholar
  37. 37.
    West R, Liang L, Fonarow GC, Kociol R, Mills RM, O’Connor CM, et al. Characterization of heart failure patients with preserved ejection fraction: a comparison between ADHERE-US registry and ADHERE-International registry. Eur J Heart Fail. 2011;13(9):945–52.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Senni M, Gavazzi A, Oliva F, Mortara A, Urso R, Pozzoli M, et al. In-hospital and 1-year outcomes of acute heart failure patients according to presentation (de novo vs. worsening) and ejection fraction. Results from IN-HF Outcome Registry. Int J Cardiol. 2014;173(2):163–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet. 2003;362:777–81.PubMedCrossRefGoogle Scholar
  40. 40.
    Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB, Kitzman DW, et al. Effects of digoxin on morbidity and mortality in diastolic heart failure; the ancillary digitalis investigation group trial. Circulation. 2006;114:266–70.CrossRefGoogle Scholar
  41. 41.
    Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J. 2006;27:2338–45.PubMedCrossRefGoogle Scholar
  42. 42.
    Yip GWK, Wang M, Wang T, Chan S, Fung JW, Yeung L, et al. The Hong Kong diastolic heart failure study: a randomized controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection. Heart. 2008;94:573–80.PubMedCrossRefGoogle Scholar
  43. 43.
    Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359:2456–67.PubMedCrossRefGoogle Scholar
  44. 44.
    van Veldhuisen DJ, Cohen-Solal A, Böhm M, Anker SD, Babalis D, Roughton M, et al. SENIORS Investigators. Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: data from SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure). J Am Coll Cardiol. 2009;53(23):2150–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383–92.PubMedCrossRefGoogle Scholar
  46. 46.
    Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT, et al. Systolic and diastolic heart failure in the community. JAMA. 2006;296:2209–16.PubMedCrossRefGoogle Scholar
  47. 47.
    Lee DS, Gona P, Vasan RS, Larson MG, Benjamin EJ, Wang TJ, et al. Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the Framingham Heart Study of the national heart, lung, and blood institute. Circulation. 2009;119:3070–7.PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Brouwers FP, de Boer RA, van der Harst P, Voors AA, Gansevoort RT, Bakker SJ, et al. Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort: 11-year follow-up of PREVEND. Eur Heart J. 2013;34(19):1424–31.PubMedCrossRefGoogle Scholar
  49. 49.
    Adabag S, Smith LG, Anand IS, Berger AK, Luepker RV. Sudden cardiac death in heart failure patients with preserved ejection fraction. J Card Fail. 2012;18(10):749–54.PubMedCrossRefGoogle Scholar
  50. 50.
    Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D, et al. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure. Circ Heart Fail. 2012;5(4):414–21.PubMedCrossRefGoogle Scholar
  51. 51.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA. 2003;289:2560–72.PubMedCrossRefGoogle Scholar
  52. 52.
    Choudhury L, Gheorghiade M, Bonow RO. Coronary artery disease in patients with heart failure and preserved systolic function. Am J Cardiol. 2002;89:719–22.PubMedCrossRefGoogle Scholar
  53. 53.
    Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557–62.PubMedCrossRefGoogle Scholar
  54. 54.
    van Heerebeek L, Hamdani N, Handoko ML, Falcao-Pires I, Musters RJ, Kupreishvili K, et al. Diastolic stiffness of the failing diabetic heart: importance of fibrosis, advanced glycation end products, and myocyte resting tension. Circulation. 2008;117:43–51.PubMedCrossRefGoogle Scholar
  55. 55.
    He KL, Dickstein M, Sabbah HN, Yi GH, Gu A, Maurer M, et al. Mechanisms of heart failure with well-preserved ejection fraction in dogs following limited coronary microembolization. Cardiovasc Res. 2004;64:72–83.PubMedCrossRefGoogle Scholar
  56. 56.
    Asanuma T, Uranishi A, Masuda K, Ishikura F, Beppu S, Nakatani S. Assessment of myocardial ischemic memory using persistence of post-systolic thickening after recovery from ischemia. JACC Cardiovasc Imaging. 2009;2:1253–61.PubMedCrossRefGoogle Scholar
  57. 57.
    Zakeri R, Borlaug BA, McNulty SE, Mohammed SF, Lewis GD, Semigran MJ, et al. Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study. Circ Heart Fail. 2014;7(1):123–30.PubMedCrossRefGoogle Scholar
  58. 58.•
    Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014 May 29. This study examines the role and association of right ventricular dysfunction in HFpEF patients.Google Scholar
  59. 59.
    Vaduganathan M, Fonarow GC. Epidemiology of hospitalised heart failure: differences and similarities between patients with reduced versus preserved ejection fraction. Heart Fail Clin. 2013;9(3):271–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Ahmed A, Allman RM, Fonarow GC, Love TE, Zannad F, Dell’italia LJ, et al. Incident heart failure hospitalization and subsequent mortality in chronic heart failure: a propensity-matched study. J Card Fail. 2008;14(3):211–8.PubMedCentralPubMedCrossRefGoogle Scholar
  61. 61.
    Bueno H, Ross JS, Wang Y, Chen J, Vidán MT, Normand SL, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA. 2010;303(21):2141–7.PubMedCentralPubMedCrossRefGoogle Scholar
  62. 62.
    Ross JS, Chen J, Lin Z, Bueno H, Curtis JP, Keenan PS, et al. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail. 2010;3(1):97–103.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.•
    Campbell RT, Jhund PS, Castagno D, Hawkins NM, Petrie MC, McMurray JJ. What have we learned about patients with heart failure and preserved ejection fraction from DIG-PEF, CHARM-preserved, and I-PRESERVE? J Am Coll Cardiol. 2012;60(23):2349–56. This editorial compares outcomes for patients enrolled in few clinical trials among HFpEF patients.PubMedCrossRefGoogle Scholar
  64. 64.
    Chan MM, Lam CS. How do patients with heart failure with preserved ejection fraction die? Eur J Heart Fail. 2013;15:604–13.PubMedCrossRefGoogle Scholar
  65. 65.••
    Somaratne JB, Berry C, McMurray JJ, Poppe KK, Doughty RN, Whalley GA. The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis. Eur J Heart Fail. 2009;11:855–62. This meta-analysis reported lower mortality rate among HFpEF patients than HFrEF.PubMedCrossRefGoogle Scholar
  66. 66.
    Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J. 2012;33(14):1750–7.CrossRefGoogle Scholar
  67. 67.
    Henkel DM, Redfield MM, Weston SA, Gerber Y, Roger VL. Death in heart failure: a community perspective. Circ Heart Fail. 2008;1:91–7.PubMedCentralPubMedCrossRefGoogle Scholar
  68. 68.
    Lam CS, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011;13(1):18–28.PubMedCentralPubMedCrossRefGoogle Scholar
  69. 69.
    Komajda M, Carson PE, Hetzel S, McKelvie R, McMurray JJ, Ptaszynska A, et al. Factors associated with outcome in heart failure with preserved ejection fraction: findings from the Irbesartan in heart failure with preserved ejection fraction study (I-PRESERVE). Circ Heart Fail. 2011;4:27–35.PubMedCrossRefGoogle Scholar
  70. 70.
    Setaro JF, Zaret BL, Schulman DS, Black HR, Soufer R. Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance. Am J Cardiol. 1990;66(12):981–6.PubMedCrossRefGoogle Scholar
  71. 71.
    Aronow WS, Kronzon I. Effect of enalapril on congestive heart failure treated with diuretics in elderly patients with prior myocardial infarction and normal left ventricular ejection fraction. Am J Cardiol. 1993;71(7):602–4.PubMedCrossRefGoogle Scholar
  72. 72.
    Aronow WS, Ahn C, Kronzon I. Effect of propranolol versus no propranolol on total mortality plus nonfatal myocardial infarction in older patients with prior myocardial infarction, congestive heart failure, and left ventricular ejection fraction > or =40 % treated with diuretics plus angiotensin-converting enzyme inhibitors. Am J Cardiol. 1997;80(2):207–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Nodari S, Metra M, Dei CL. Beta-blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs. nebivolol. Eur J Heart Fail. 2003;5(5):621–7.PubMedCrossRefGoogle Scholar
  74. 74.
    Takeda Y, Fukutomi T, Suzuki S, Yamamoto K, Ogata M, Kondo H, et al. Effects of carvedilol on plasma B-type natriuretic peptide concentration and symptoms in patients with heart failure and preserved ejection fraction. Am J Cardiol. 2004;94(4):448–53.PubMedCrossRefGoogle Scholar
  75. 75.
    Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ, Parkhomenko A, Borbola J, et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J. 2005;26:215–25.PubMedCrossRefGoogle Scholar
  76. 76.
    Tehrani F, Morrissey R, Phan A, Chien C, Schwarz ER. Statin therapy in patients with diastolic heart failure. Clin Cardiol. 2010;35:e1–5.Google Scholar
  77. 77.
    Solomon SD, Zile M, Pieske B, Voors A, Shah A, Kraigher-Krainer E, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet. 2012;380(9851):1387–95.PubMedCrossRefGoogle Scholar
  78. 78.
    Edelmann F, Wachter R, Schmidt AG, Kraigher-Krainer E, Colantonio C, Kamke W, et al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial. JAMA. 2013;309(8):781–91.PubMedCrossRefGoogle Scholar
  79. 79.
    Yamamoto K, Origasa H, Hori M. J-DHF Investigators. Effects of carvedilol on heart failure with preserved ejection fraction: the Japanese Diastolic Heart Failure Study (J-DHF). Eur J Heart Fail. 2013;15(1):110–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Maier LS, Layug B, Karwatowska-Prokopczuk E, Belardinelli L, Lee S, Sander J, et al. RAnoLazIne for the treatment of diastolic heart failure in patients with preserved ejection fraction: the RALI-DHF proof-of-concept study. JACC Heart Fail. 2013;1(2):115–22.PubMedCrossRefGoogle Scholar
  81. 81.
    Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N Engl J Med. 1991; 325(5):293–302.Google Scholar
  82. 82.
    Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353(9169):2001–7.Google Scholar
  83. 83.
    Cuspidi C, Meani S, Fusi V, Valerio C, Catini E, Sala C, et al. Prevalence and correlates of left atrial enlargement in essential hypertension: role of ventricular geometry and the metabolic syndrome: the Evaluation of Target Organ Damage in Hypertension study. J Hypertens. 2005;23:875–82.PubMedCrossRefGoogle Scholar
  84. 84.
    Sica DA, Gehr TWB, Frishman WH. Use of diuretics in the treatment of heart failure in the elderly. Clin Geriatr Med. 2007;23:107–21.PubMedCrossRefGoogle Scholar
  85. 85.
    Maier LS. New treatment options for late Na current, arrhythmias, and diastolic dysfunction. Curr Heart Fail Rep. 2012;9:183–91.PubMedCentralPubMedCrossRefGoogle Scholar
  86. 86.
    Kitzman DW, Brubaker PH, Morgan TM, Stewart KP, Little WC. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail. 2010;3:659–67.PubMedCentralPubMedCrossRefGoogle Scholar
  87. 87.
    Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol. 2013;62:584–92.PubMedCentralPubMedCrossRefGoogle Scholar
  88. 88.
    Stone HP, Chaitman BR, Stocke K, Sano J, DeVault A, Koch GG. The anti-ischemic action of ranolazine in stable ischemic heart disease. J Am Coll Cardiol. 2010;56:934–442.PubMedCrossRefGoogle Scholar
  89. 89.
    Berry JD, Pandey A, Gao A, Leonard D, Farzaneh-Far R, Ayers C, et al. Physical fitness and risk for heart failure and coronary artery disease. Circ Heart Fail. 2013;6(4):627–34.PubMedCrossRefGoogle Scholar
  90. 90.•
    Brinker SK, Pandey A, Ayers CR, Barlow CE, DeFina LF, Willis BL, et al. Association of cardiorespiratory fitness with left ventricular remodeling and diastolic function: the cooper center longitudinal study. JACC Heart Fail. 2014;2(3):238–46. This study shows poorer diastolic and other structural measures among participants with lower fitness level.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Abhinav Dhingra
    • 1
  • Aayushi Garg
    • 1
  • Simrat Kaur
    • 2
  • Saurav Chopra
    • 1
  • Jaspreet Singh Batra
    • 3
  • Ambarish Pandey
    • 4
  • Antoine H. Chaanine
    • 5
  • Sunil K. Agarwal
    • 5
    • 6
  1. 1.All India Institute of Medical SciencesNew DelhiIndia
  2. 2.Dayanand Medical College and HospitalLudhianaIndia
  3. 3.Weill Cornell Medical CollegeNew YorkUSA
  4. 4.University of Texas Southwestern Medical CenterDallasUSA
  5. 5.Johns Hopkins UniversityBaltimoreUSA
  6. 6.Mount Sinai Health SystemsNew YorkUSA

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