Treatment of Heart Failure With Preserved Ejection Fraction: Reflections on Its Treatment With an Aldosterone Antagonist | Cardiology | JAMA Cardiology | JAMA Network
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April 2016

Treatment of Heart Failure With Preserved Ejection Fraction: Reflections on Its Treatment With an Aldosterone Antagonist

Author Affiliations
  • 1Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
JAMA Cardiol. 2016;1(1):7-8. doi:10.1001/jamacardio.2015.0356

Heart failure (HF) with preserved ejection fraction (HFpEF) is a syndrome that occurs in about one-half of all patients with HF and is being recognized with increasing frequency. Although its specific causes have not been elucidated in the majority of patients, HFpEF occurs most commonly in elderly individuals who have 1 or more comorbidities that include hypertension, obesity, diabetes, metabolic syndrome, atrial fibrillation, anemia, and chronic kidney disease. While by its usual definition the left ventricular ejection fraction is 45% or more (and in some instances ≥50%), HFpEF may also be characterized by diastolic dysfunction that impairs ventricular filling resulting from slowed ventricular relaxation and an increase in passive ventricular stiffness. In some patients with HFpEF, this elevation in filling pressure is manifest only during exercise, whereas in others it is more sustained, and results in pulmonary hypertension.1

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