HEART FAILURE WITH PRESERVED EJECTION FRACTION Flashcards
What is diastolic dysfunction (DD)?
Defined as increased viscoelastic chamber stiffness, impaired ventricular relaxation, or a combination of both.
What conditions may accelerate the decline in left ventricular compliance associated with DD?
Hypertension, diabetes, and obesity.
Can diastolic dysfunction occur in the absence of systolic dysfunction?
Yes, DD can occur with or without systolic dysfunction.
What symptoms can diastolic dysfunction lead to?
Dyspnea, orthopnea, and bilateral lower extremity swelling.
What is heart failure with preserved ejection fraction (HFpEF)?
A condition where impaired relaxation leads to increased left ventricular filling pressures, promoting HF symptoms.
What is the prevalence of HFpEF in individuals with heart failure?
Approximately 50% of individuals with heart failure have HFpEF.
What is the projected cost of HFpEF to the U.S. healthcare system by 2030?
~$70 billion.
Who are the individuals at highest risk of HFpEF?
Older women.
What are some risk factors for HFpEF?
Hypertension, obesity, physical inactivity, coronary artery disease, and atrial fibrillation.
What is the in-hospital mortality rate for HFpEF?
Ranges from 2.4% to 4.9%.
What is the 5-year mortality rate after hospitalization for HFpEF?
Roughly 40%.
What are some pathophysiological mechanisms contributing to HFpEF?
Chronotropic incompetence, autonomic dysfunction, systemic and pulmonary vascular dysfunction, reduced nitric oxide availability, and RV dysfunction.
What can precipitate decompensated HFpEF?
Uncontrolled blood pressure, atrial fibrillation, nonadherence to diuretic therapy, high sodium intake, myocardial ischemia, sepsis, and acute renal dysfunction.
How is HFpEF diagnosed?
Based primarily on signs and symptoms, with criteria including LVEF ≥50% and elevated LV filling pressures.
What are first-line diagnostic tools for suspected HFpEF?
Echocardiography, natriuretic peptide levels, and objective assessment of functional capacity.
Which echocardiographic parameters are used to assess diastolic dysfunction?
Biplane LA maximum volume index, E/e9 ratio, early diastolic velocity at septal and lateral sides, and peak TR velocity.
What classification is used for diastolic dysfunction based on mitral velocities?
Grade I, Grade II, Grade III DD, and indeterminate diastolic function.
What is the annual death rate for HFpEF in the United States?
8% to 12%.
What are some characteristics of patients with HFpEF compared to healthy individuals?
Lower lean total body and leg mass, higher intramuscular fat content, lower type 1 muscle fibers, and lower capillary density.
What is the lifetime risk of developing HFpEF for non-Black individuals compared to Black individuals?
11.2% for non-Black vs. 7.7% for Black individuals.
True or False: Diastolic dysfunction is necessary for the diagnosis of HFpEF.
False.
What are some advanced testing methods for diagnosing HFpEF?
Cardiac MRI, technetium pyrophosphate scintigraphy scan, and endomyocardial biopsy.
What is the role of cardiac MRI in assessing diastolic function?
To derive parameters such as LV mass, LA size and function, and myocardial deformation.
What specific cardiac diseases require a different approach in management?
Atrial fibrillation, hypertrophic cardiomyopathy, group I, III, or IV pulmonary hypertension, moderate or severe mitral annular calcification, significant mitral valve disease
