HFrEF occurs when the left ventricular ejection fraction (LVEF) is 40% or less and is accompanied by progressive left ventricular dilatation and adverse cardiac remodeling. -Heart Failure With Reduced Ejection Fraction: A Review - PubMed (nih.gov)
Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%;[1] this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).[1]
Risk factors for HFpEF include hypertension, hyperlipidemia, diabetes, smoking, and obstructive sleep apnea.
HFpEF is characterized by abnormal diastolic function: there is an increase in the stiffness of the left ventricle, which causes a decrease in left ventricular relaxation during diastole, with resultant increased pressure and/or impaired filling.[2] There is an increased risk for atrial fibrillation and pulmonary hypertension.
For example, explain that patients with HFrEF feel better and live longer with “triple therapy”
1)...an ACEI, ARB, or Entresto (sacubitril/valsartan)
2)PLUS an evidence-based beta-blocker (carvedilol, etc)
3) AND aldosterone antagonist (spironolactone, etc).
- Eur J Heart Fail Published online Sep 18, 2020; doi:10.1002/ejhf.2008
- J Am Coll Cardiol 2018;71(2):201-30
- Circulation 2016;134(6):e32-e69
- J Card Fail 2011;17(8):664-9
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