Cardiovascular Medicine and Cardiac Surgery

Biography

Biography: Samer Ellahham

Abstract

Nearly half of all patients with heart failure have a normal ejection fraction (EF). The prevalence of this syndrome, termed heart failure with preserved ejection fraction (HFpEF), continues to increase likely because of the increasing prevalence of common risk factors, including older age, female gender, hypertension, renal dysfunction, metabolic syndrome and obesity. In contrast to heart failure with reduced ejection fraction (HFrEF), no treatment has been proven in pivotal clinical trials to be effective for HFpEF, largely because of the pathophysiological heterogeneity that exists within the broad spectrum of HFpEF. This syndrome was historically considered to be caused exclusively by left ventricular diastolic dysfunction, but research has identified several other contributory factors, including limitations in left ventricular systolic reserve, systemic and pulmonary vascular function, nitric oxide bioavailability, chronotropic reserve, right heart function, autonomic tone, left atrial function and peripheral impairments. Multiple individual mechanisms frequently coexist within the same patient to cause symptomatic heart failure, but between patients with HFpEF the extent to which each component is operative can differ widely, confounding treatment approaches. Clinical trials have not yet identified effective treatments for HFpEF. Incomplete understanding of the pathophysiology of HFpEF, the likelihood that there is substantial pathophysiologic heterogeneity among affected patients and the interplay of various risk factors has all been barriers in the development of effective treatments. Ongoing research initiatives are critically important as there is a rapid increase in number of patients with this form of heart failure.

Learning Objectives: Objectives are to: Demonstrate the association between heart failure with preserved ejection fraction (HFpEF) and survival; given a patient with heart failure (HF), recognize HFpEF on the basis of clinical signs and symptoms, physical examination, echocardiography, and radiographic findings; classify patients at high risk of hospitalization and mortality through assessing risk factors, clinical presentation and interpretation of biomarkers; distinguish the clinical presentation, diagnosis and treatment strategies of HFpEF from those of HF with reduced ejection fraction; given a patient with HFpEF, develop an individualized treatment plan based on current evidence; assess the potential role of future pharmacotherapies for HFpEF.