HEART FAILURE WITH PRESERVED EJECTION FRACTION: ADVANCES IN DIAGNOSIS AND TREATMENT, WITH SPECIAL EMPHASIS ON OBESITY AND THE ELDERLY PATIENT

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0812

Abstract

Heart failure with preserved ejection fraction (HFpEF) accounts for roughly half of heart failure cases and its prevalence is rising due to an aging population and increasing rates of obesity and metabolic disorders (1) (2). HFpEF is characterized by signs and symptoms of congestion despite normal ejection fraction, resulting from diastolic dysfunction and extracardiac abnormalities. Over the past decade, important advances have occurred in HFpEF diagnosis and treatment. In diagnosis, beyond traditional Doppler echocardiography, advanced imaging such as global longitudinal strain and clinical-echo scores (H_2FPEF and HFA-PEFF) have improved identification of HFpEF among patients with unexplained dyspnea. Natriuretic peptides remain key biomarkers, though their interpretation requires caution in obese patients. In treatment, while control of comorbidities and diuretic use for symptom relief remain central, new therapies have shown clinical benefits. In particular, SGLT2 inhibitors reduce heart failure hospitalizations in HFpEF (11) (12) and are now recommended (class IIa), whereas sacubitril/valsartan (ARNI) and mineralocorticoid receptor antagonists confer modest benefits in subgroups and carry class IIb recommendations. HFpEF in obese patients represents a prevalent and challenging phenotype requiring comprehensive management focused on weight reduction. In older adults, HFpEF is common and often coexists with frailty and specific etiologies such as transthyretin amyloidosis, demanding individualized management. Here we critically review recent advances in HFpEF diagnosis and treatment, with an emphasis on obesity and older adults, in light of current evidence.

Keywords: Heart failure with preserved ejection fraction; Obesity; Metabolic syndrome; Aged; Echocardiography; Biomarkers; Treatment.