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Heart Failure with Normal Ejection Fraction

In around half of patients diagnosed with heart failure, a relatively preserved systolic function (LVEF>0.40) is found.

Heart Failure (HF)

The diagnosis of heart failure with normal ejection fraction (HFNEF) requires three conditions to be satisfied:
1) signs or symptoms of heart failure;
2) normal LV function;
3) evidence of diastolic LV dysfunction.

Tissue Doppler or cardiac catheterisation provide evidence of diastolic dysfunction. Natriuretic peptides need to be combined with blood flow Doppler, LV mass index, LA volume index or presence of AF to provide evidence of diastolic LV dysfunction.

Treatment of diastolic heart failure is hampered by the absence of evidence for a specific drug that can reduce mortality and morbidity in these patients.

Theoretically, a number of treatments might benefit patients with HFNEF, but the development of treatment has been neglected until recently. To date we have no definitive data that any treatment improves outcome in HFNEF and no treatment is approved for this indication.

For example, blockers of the renin-angiotensin system, such as ACE-inhibitors, angiotensin receptor blockers (ARBs)and aldosterone antagonists are of particular interest, but strong evidence for their beneficial effect is still lacking and the results of some studies (CHARM-preserved with candesartan, PEP-CHF with perindopril and VALIDD with valsartan) were not positive.

Two large trials with RAAS blockade are ongoing, namely I-PRESERVE with irbesartan and TOPCAT with spironolactone and their results are expected soon. Many other interesting possibilities concern newer agents (alagebrium, ivabradine, ranolazine).


In my opinion, heart failure with normal ejection fraction is an interesting and important topic, but today, we still need to acquire more knowledge about the physiopathology, and we need specific clinical studies with adequate selection of patients to tailor therapeutic strategy for this indication.


Webcast Webcasts of Presentations availableW. Paulus  ,  JJV Mc Murray




Heart Failure with Normal Ejection Fraction

Notes to editor

This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.