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Heart failure preserved ejection fraction (HFpEF): an integrated and strategic review

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Abstract

In the USA, 5.7 million Americans ≥20 years have heart failure (HF) and heart failure preserved ejection fraction (HFpEF) accounts for at least 50 % of all hospital admissions for HF. HFpEF has no single guideline for diagnosis or treatment, the patient population is heterogeneously and inconsistently described, and longitudinal studies are lacking. The primary aims of this manuscript were to present an integrated review of the current state of the science on HFpEF, demonstrate gaps in the literature and provide the rationale for the design and implementation of future research to yield insights into the syndrome of HFpEF. The scientific literature was comprehensively reviewed on HFpEF pathophysiology, patient characteristics, diagnostic criteria, echocardiography biomarkers, treatment approaches and outcomes. Discrepancies in patient characteristics, diagnostic criteria, study methods and echocardiographic biomarkers were identified. This review indicates that no single test or guideline exists for diagnosis or treatment for HFpEF; heterogeneity of the population is complicated by multiple comorbidities that factor into etiology, race and age are likely important factors that define the phenotype, and limited information is available that designates early markers of impending HFpEF. Studies designed and adequately powered to study the impact of race and age along with consistent use of HFpEF diagnostic criteria are critically needed to further incident HFpEF research.

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References

  1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62(16):e147–e239. doi:10.1016/j.jacc.2013.05.019

    Article  PubMed  Google Scholar 

  2. Wong CM, Hawkins NM, Jhund PS, MacDonald MR, Solomon SD, Granger CB, Yusuf S, Pfeffer MA, Swedberg K, Petrie MC, McMurray JJ (2013) Clinical characteristics and outcomes of young and very young adults with heart failure: the CHARM programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity). J Am Coll Cardiol 62(20):1845–1854. doi:10.1016/j.jacc.2013.05.072

    Article  PubMed  Google Scholar 

  3. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259

    Article  CAS  PubMed  Google Scholar 

  4. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB (2015) Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 131(4):e29–e322. doi:10.1161/cir.0000000000000152

    Article  PubMed  Google Scholar 

  5. AlJaroudi W, Alraies MC, Halley C, Rodbriguez I, Grim RA, Thomas JD, Jaber WA (2012) Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction. Circulation 1(24):24–30

    Google Scholar 

  6. Gladden JD, Linke WA, Redfield MM (2014) Heart failure with preserved ejection fraction. Pflugers Arch. doi:10.1007/s00424-014-1480-8

    PubMed Central  PubMed  Google Scholar 

  7. Little WC, Zile MR (2012) HFpEF: cardiovascular abnormalities not just comorbidities. Circ Heart Fail 5(6):669–671. doi:10.1161/circheartfailure.112.972265

    Article  PubMed  Google Scholar 

  8. Borlaug BA, Kass DA (2011) Ventricular-vascular interaction in heart failure. Cardiol Clin 29(3):447–459. doi:10.1016/j.ccl.2011.06.004

    Article  PubMed  Google Scholar 

  9. Borlaug BA, Jaber WA, Ommen SR, Lam CS, Redfield MM, Nishimura RA (2011) Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction. Heart 97(12):964–969. doi:10.1136/hrt.2010.212787

    Article  PubMed Central  PubMed  Google Scholar 

  10. Borlaug BA, Olson TP, Lam CS, Flood KS, Lerman A, Johnson BD, Redfield MM (2010) Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction. J Am Coll Cardiol 56(11):845–854. doi:10.1016/j.jacc.2010.03.077

    Article  PubMed Central  PubMed  Google Scholar 

  11. Paulus WJ, Tschope C (2013) A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 62(4):263–271. doi:10.1016/j.jacc.2013.02.092

    Article  PubMed  Google Scholar 

  12. Pickering TG (2004) Reflections in hypertension: heart failure and hypertension: the diastolic dilemma. J Clin Hypertens (Greenwich) 6(11):647–650

    Article  Google Scholar 

  13. Borlaug BA, Paulus WJ (2011) Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 32(6):670–679. doi:10.1093/eurheartj/ehq426

    Article  PubMed Central  PubMed  Google Scholar 

  14. Antonini-Canterin F, Poli S, Vriz O, Pavan D, Bello V, Nicolosi G (2013) The ventricular-arterial coupling: from basic pathophysiology to clinical application in the echocardiography laboratory. J Cardiovas Echocardiogr 23(4):91–95. doi:10.4103/2211-4122.127408

    Article  Google Scholar 

  15. Lam CS, Shah AM, Borlaug BA, Cheng S, Verma A, Izzo J, Oparil S, Aurigemma GP, Thomas JD, Pitt B, Zile MR, Solomon SD (2013) Effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency. Eur Heart J 34(9):676–683. doi:10.1093/eurheartj/ehs299

    Article  CAS  PubMed  Google Scholar 

  16. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22(2):107–133. doi:10.1016/j.echo.2008.11.023

    Article  PubMed  Google Scholar 

  17. Brutsaert DL, Sys SU, Gillebert TC (1993) Diastolic failure: pathophysiology and therapeutic implications. J Am Coll Cardiol 22(1):318–325

    Article  CAS  PubMed  Google Scholar 

  18. Libby PBE (2008) Braunwald’s heart disease: a textbook of cardiovascular medicine. Philadelphia: Saunders/Elsevier. Available via OCLC. http://catdir.loc.gov/catdir/toc/ecip0712/2007009890.html. Materials specified: Table of contents only http://catdir.loc.gov/catdir/toc/ecip0712/2007009890.html

  19. Braunwald E, Zipes DPLP (2001) Heart disease: a textbook of cardiovascular medicine, 6th edn. Saunders, Philadelphia

    Google Scholar 

  20. Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, Marino P, Smiseth OA, De Keulenaer G, Leite-Moreira AF, Borbely A, Edes I, Handoko ML, Heymans S, Pezzali N, Pieske B, Dickstein K, Fraser AG, Brutsaert DL (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 28(20):2539–2550. doi:10.1093/eurheartj/ehm037

    Article  PubMed  Google Scholar 

  21. Hanrath P, Mathey DG, Siegert R, Bleifeld W (1980) Left ventricular relaxation and filling pattern in different forms of left ventricular hypertrophy: an echocardiographic study. Am J Cardiol 45(1):15–23

    Article  CAS  PubMed  Google Scholar 

  22. Dunlay SM, Roger VL, Weston SA, Jiang R, Redfield MM (2012) Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction. Circ Heart Fail 5(6):720–726. doi:10.1161/circheartfailure.111.966366

    Article  PubMed Central  PubMed  Google Scholar 

  23. Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM (2009) Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol 53(13):1119–1126. doi:10.1016/j.jacc.2008.11.051

    Article  PubMed Central  PubMed  Google Scholar 

  24. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289(2):194–202

    Article  PubMed  Google Scholar 

  25. Otto C (2004) Textbook of Clinical Echocardiography, 3rd edn. Elseiver, Philadelphia

    Google Scholar 

  26. Feigenbaum H, Armstrong W, Ryan T (2005) Feigenbaum’s echocardiography. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  27. Borlaug BA, Nishimura RA, Sorajja P, Lam CS, Redfield MM (2010) Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail 3(5):588–595. doi:10.1161/circheartfailure.109.930701

    Article  PubMed Central  PubMed  Google Scholar 

  28. Borlaug BA, Redfield MM (2011) Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation 123(18):2006–2013. doi:10.1161/CIRCULATIONAHA.110.954388 (discussion 2014)

    Article  PubMed Central  PubMed  Google Scholar 

  29. Kawaguchi M, Hay I, Fetics B, Kass DA (2003) Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation 107(5):714–720

    Article  PubMed  Google Scholar 

  30. Borlaug BA, Kass DA (2009) Invasive hemodynamic assessment in heart failure. Heart Fail Clin 5(2):217–228. doi:10.1016/j.hfc.2008.11.008

    Article  PubMed Central  PubMed  Google Scholar 

  31. Borlaug BA, Lam CS, Roger VL, Rodeheffer RJ, Redfield MM (2009) Contractility and ventricular systolic stiffening in hypertensive heart disease insights into the pathogenesis of heart failure with preserved ejection fraction. J Am Coll Cardiol 54(5):410–418. doi:10.1016/j.jacc.2009.05.013

    Article  PubMed Central  PubMed  Google Scholar 

  32. Chen CH, Fetics B, Nevo E, Rochitte CE, Chiou KR, Ding PA, Kawaguchi M, Kass DA (2001) Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol 38(7):2028–2034

    Article  CAS  PubMed  Google Scholar 

  33. Ky B, French B, May Khan A, Plappert T, Wang A, Chirinos JA, Fang JC, Sweitzer NK, Borlaug BA, Kass DA, St John Sutton M, Cappola TP (2013) Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure. J Am Coll Cardiol 62(13):1165–1172. doi:10.1016/j.jacc.2013.03.085

    Article  PubMed Central  PubMed  Google Scholar 

  34. Ersboll M, Valeur N, Mogensen UM, Andersen MJ, Moller JE, Velazquez EJ, Hassager C, Sogaard P, Kober L (2013) Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction. J Am Coll Cardiol 61(23):2365–2373. doi:10.1016/j.jacc.2013.02.061

    Article  PubMed  Google Scholar 

  35. Hasselberg NE, Haugaa KH, Sarvari SI, Gullestad L, Andreassen AK, Smiseth OA, Edvardsen T (2015) Left ventricular global longitudinal strain is associated with exercise capacity in failing hearts with preserved and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 16(2):217–224. doi:10.1093/ehjci/jeu277

    Article  PubMed Central  PubMed  Google Scholar 

  36. Yoon H, Alenezi F, Ersboll M, Khouri M, Samad Z, Velazquez E (2014) Global longitudinal strain is impaired in hospitalized acute heart failure patients with preserved ejection fraction. J Am Coll Cardiol. doi:10.1016/S0735-1097(14)60554-4

    Google Scholar 

  37. Mewton N, Liu CY, Croisille P, Bluemke D, Lima JA (2011) Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 57(8):891–903. doi:10.1016/j.jacc.2010.11.013

    Article  PubMed  Google Scholar 

  38. Desai CS, Haines P, Zamani P, Konda P, Shiva-Kumar P, Peddireddy S, Shekhar R, Jain S, Kers S, Ferrari V, Chirinos J (2014) Diffuse myocardial fibrosis is greatly elevated in males with heart failure with reduced ejection fraction, but not heart failure with preserved ejection fraction. J Am Coll Cardiol. doi:10.1016/S0735-1097(14)60967-0

    Google Scholar 

  39. Steinberg BA, Zhao X, Heidenreich PA, Peterson ED, Bhatt DL, Cannon CP, Hernandez AF, Fonarow GC (2012) Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation 126(1):65–75. doi:10.1161/circulationaha.111.080770

    Article  PubMed  Google Scholar 

  40. Melenovsky V, Borlaug BA, Rosen B, Hay I, Ferruci L, Morell CH, Lakatta EG, Najjar SS, Kass DA (2007) Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community: the role of atrial remodeling/dysfunction. J Am Coll Cardiol 49(2):198–207. doi:10.1016/j.jacc.2006.08.050

    Article  PubMed  Google Scholar 

  41. Zakeri R, Chamberlain AM, Roger VL, Redfield MM (2013) Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study. Circulation 128(10):1085–1093. doi:10.1161/circulationaha.113.001475

    Article  PubMed Central  PubMed  Google Scholar 

  42. Vasan RS, Levy D (2000) Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation 101(17):2118–2121

    Article  CAS  PubMed  Google Scholar 

  43. Yturralde RF, Gaasch WH (2005) Diagnostic criteria for diastolic heart failure. Prog Cardiovasc Dis 47(5):314–319

    Article  PubMed  Google Scholar 

  44. European Study Group on Diastolic Heart Failure (1998) How to diagnose diastolic heart failure. Eur Heart J 19(7):990–1003

    Article  Google Scholar 

  45. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285(26):1441–1446. doi:10.1056/nejm197112232852601

    Article  CAS  PubMed  Google Scholar 

  46. Fukuta H, Sane DC, Brucks S, Little WC (2005) Statin therapy may be associated with lower mortality in patients with diastolic heart failure: a preliminary report. Circulation 112(3):357–363. doi:10.1161/circulationaha.104.519876

    Article  CAS  PubMed  Google Scholar 

  47. Pfeffer MA, Claggett B, Assmann SF, Boineau R, Anand IS, Clausell N, Desai AS, Diaz R, Fleg JL, Gordeev I, Heitner JF, Lewis EF, O’Meara E, Rouleau JL, Probstfield JL, Shaburishvili T, Shah SJ, Solomon SD, Sweitzer NK, McKinlay SM, Pitt B (2015) Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. Circulation 131(1):34–42. doi:10.1161/circulationaha.114.013255

    Article  CAS  PubMed  Google Scholar 

  48. Haywood GA, Gullestad L, Katsuya T, Hutchinson HG, Pratt RE, Horiuchi M, Fowler MB (1997) AT1 and AT2 angiotensin receptor gene expression in human heart failure. Circulation 95(5):1201–1206

    Article  CAS  PubMed  Google Scholar 

  49. Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J (2006) The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 27(19):2338–2345. doi:10.1093/eurheartj/ehl250

    Article  CAS  PubMed  Google Scholar 

  50. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 362(9386):777–781. doi:10.1016/s0140-6736(03)14285-7

    Article  CAS  PubMed  Google Scholar 

  51. Rogers JK, Pocock SJ, McMurray JJ, Granger CB, Michelson EL, Ostergren J, Pfeffer MA, Solomon SD, Swedberg K, Yusuf S (2014) Analysing recurrent hospitalizations in heart failure: a review of statistical methodology, with application to CHARM-Preserved. Eur J Heart Fail 16(1):33–40. doi:10.1002/ejhf.29

    Article  PubMed  Google Scholar 

  52. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A (2008) Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 359(23):2456–2467. doi:10.1056/NEJMoa0805450

    Article  CAS  PubMed  Google Scholar 

  53. Schwartzenberg S, Redfield MM, From AM, Sorajja P, Nishimura RA, Borlaug BA (2012) Effects of vasodilation in heart failure with preserved or reduced ejection fraction implications of distinct pathophysiologies on response to therapy. J Am Coll Cardiol 59(5):442–451. doi:10.1016/j.jacc.2011.09.062

    Article  PubMed  Google Scholar 

  54. Kao DP, Lewsey JD, Anand IS, Massie BM, Zile MR, Carson PE, McKelvie RS, Komajda M, McMurray JJ, Lindenfeld J (2015) Characterization of subgroups of heart failure patients with preserved ejection fraction with possible implications for prognosis and treatment response. Eur J Heart Fail. doi:10.1002/ejhf.327

    PubMed  Google Scholar 

  55. Sacubitril/Valsartan (Entresto) for Heart Failure. JAMA 314(7):722–723 (2015). doi:10.1001/jama.2015.9398

  56. Hernandez AF, Hammill BG, O’Connor CM, Schulman KA, Curtis LH, Fonarow GC (2009) Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. J Am Coll Cardiol 53(2):184–192. doi:10.1016/j.jacc.2008.09.031

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  57. Indolfi C, Di Lorenzo E, Perrino C, Stingone AM, Curcio A, Torella D, Cittadini A, Cardone L, Coppola C, Cavuto L, Arcucci O, Sacca L, Avvedimento EV, Chiariello M (2002) Hydroxymethylglutaryl coenzyme A reductase inhibitor simvastatin prevents cardiac hypertrophy induced by pressure overload and inhibits p21ras activation. Circulation 106(16):2118–2124

    Article  CAS  PubMed  Google Scholar 

  58. Pliquett RU, Cornish KG, Peuler JD, Zucker IH (2003) Simvastatin normalizes autonomic neural control in experimental heart failure. Circulation 107(19):2493–2498. doi:10.1161/01.cir.0000065606.63163.b9

    Article  CAS  PubMed  Google Scholar 

  59. Rauchhaus M, Coats AJ, Anker SD (2000) The endotoxin-lipoprotein hypothesis. Lancet 356(9233):930–933. doi:10.1016/s0140-6736(00)02690-8

    Article  CAS  PubMed  Google Scholar 

  60. Bates K, Ruggeroli CE, Goldman S, Gaballa MA (2002) Simvastatin restores endothelial NO-mediated vasorelaxation in large arteries after myocardial infarction. Am J Physiol Heart Circ Physiol 283(2):H768–H775. doi:10.1152/ajpheart.00826.2001

    Article  CAS  PubMed  Google Scholar 

  61. Chattopadhyay S, Alamgir MF, Nikitin NP, Rigby AS, Clark AL, Cleland JG (2010) Lack of diastolic reserve in patients with heart failure and normal ejection fraction. Circ Heart Fail 3(1):35–43. doi:10.1161/circheartfailure.108.824888

    Article  PubMed  Google Scholar 

  62. Mohammed SF, Hussain S, Mirzoyev SA, Edwards WD, Maleszewski JJ, Redfield MM (2014) Coronary microvascular rarefaction and myocardial fibrosis in heart failure with preserved ejection fraction. Circulation. doi:10.1161/circulationaha.114.009625

    Google Scholar 

  63. Phan TT, Abozguia K, Nallur Shivu G, Mahadevan G, Ahmed I, Williams L, Dwivedi G, Patel K, Steendijk P, Ashrafian H, Henning A, Frenneaux M (2009) Heart failure with preserved ejection fraction is characterized by dynamic impairment of active relaxation and contraction of the left ventricle on exercise and associated with myocardial energy deficiency. J Am Coll Cardiol 54(5):402–409. doi:10.1016/j.jacc.2009.05.012

    Article  PubMed  Google Scholar 

  64. Liu CP, Ting CT, Lawrence W, Maughan WL, Chang MS, Kass DA (1993) Diminished contractile response to increased heart rate in intact human left ventricular hypertrophy. Systolic versus diastolic determinants. Circulation 88(4 Pt 1):1893–1906

    Article  CAS  PubMed  Google Scholar 

  65. Hoenig MR, Bianchi C, Rosenzweig A, Sellke FW (2008) The cardiac microvasculature in hypertension, cardiac hypertrophy and diastolic heart failure. Curr Vasc Pharmacol 6(4):292–300

    Article  CAS  PubMed  Google Scholar 

  66. Weber KT (2001) Aldosterone in congestive heart failure. N Engl J Med 345(23):1689–1697. doi:10.1056/NEJMra000050

    Article  CAS  PubMed  Google Scholar 

  67. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, Clausell N, Desai AS, Diaz R, Fleg JL, Gordeev I, Harty B, Heitner JF, Kenwood CT, Lewis EF, O’Meara E, Probstfield JL, Shaburishvili T, Shah SJ, Solomon SD, Sweitzer NK, Yang S, McKinlay SM (2014) Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 370(15):1383–1392. doi:10.1056/NEJMoa1313731

    Article  CAS  PubMed  Google Scholar 

  68. Kosmala W, Holland DJ, Rojek A, Wright L, Przewlocka-Kosmala M, Marwick TH (2013) Effect of If-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction: a randomized trial. J Am Coll Cardiol 62(15):1330–1338. doi:10.1016/j.jacc.2013.06.043

    Article  CAS  PubMed  Google Scholar 

  69. Taylor RS, Davies EJ, Dalal HM, Davis R, Doherty P, Cooper C, Holland DJ, Jolly K, Smart NA (2012) Effects of exercise training for heart failure with preserved ejection fraction: a systematic review and meta-analysis of comparative studies. Int J Cardiol 162(1):6–13. doi:10.1016/j.ijcard.2012.05.070

    Article  PubMed  Google Scholar 

  70. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Miller NH, Fleg JL, Schulman KA, McKelvie RS, Zannad F, Pina IL (2009) Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301(14):1439–1450. doi:10.1001/jama.2009.454

    Article  PubMed Central  PubMed  Google Scholar 

  71. Pandey A, Parashar A, Kumbhani DJ, Agarwal S, Garg J, Kitzman D, Levine BD, Drazner M, Berry JD (2015) Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail 8(1):33–40. doi:10.1161/circheartfailure.114.001615

    Article  PubMed  Google Scholar 

  72. Crowder RS, Irons BK, Meyerrose G, Seifert CF (2010) Factors associated with increased hospital utilization in patients with heart failure and preserved ejection fraction. Pharmacotherapy 30(7):646–653

    Article  PubMed  Google Scholar 

  73. Desai CS, Colangelo LA, Liu K, Jacobs DR Jr, Cook NL, Lloyd-Jones DM, Ogunyankin KO (2013) Prevalence, prospective risk markers, and prognosis associated with the presence of left ventricular diastolic dysfunction in young adults: the coronary artery risk development in young adults study. Am J Epidemiol 177(1):20–32. doi:10.1093/aje/kws224

    Article  PubMed Central  PubMed  Google Scholar 

  74. Gillum RF (1991) Cardiovascular disease in the United States: an epidemiologic overview. Cardiovasc Clin 21(3):3–16

    CAS  PubMed  Google Scholar 

  75. Ford ES, Cooper RS (1991) Risk factors for hypertension in a national cohort study. Hypertension 18(5):598–606

    Article  CAS  PubMed  Google Scholar 

  76. Egan BM, Zhao Y, Axon RN (2010) US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA 303(20):2043–2050. doi:10.1001/jama.2010.650

    Article  CAS  PubMed  Google Scholar 

  77. Gurwitz JH, Magid DJ, Smith DH, Hsu G, Sung SH, Allen LA, McManus DD, Goldberg RJ, Go AS (2014) The complex relationship of race to outcomes in heart failure with preserved ejection fraction. Am J Med. doi:10.1016/j.amjmed.2014.11.034

    PubMed Central  Google Scholar 

  78. Al-Dubai SA, Alshagga MA, Rampal KG, Sulaiman NA (2012) Factor structure and reliability of the Malay version of the perceived stress scale among Malaysian medical students. Malays J Med Sci 19(3):43–49

    PubMed Central  PubMed  Google Scholar 

  79. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Trogdon JG (2013) Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 6(3):606–619. doi:10.1161/HHF.0b013e318291329a

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  80. Bild DE, Detrano R, Peterson D, Guerci A, Liu K, Shahar E, Ouyang P, Jackson S, Saad MF (2005) Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 111(10):1313–1320. doi:10.1161/01.CIR.0000157730.94423.4B

    Article  PubMed  Google Scholar 

  81. East MA, Peterson ED, Shaw LK, Gattis WA, O’Connor CM (2004) Racial differences in the outcomes of patients with diastolic heart failure. Am Heart J 148(1):151–156. doi:10.1016/j.ahj.2004.01.017

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Duke University Medical Center, Duke North, Erwin Road, Suite 7400, DUMC Box 3126, Durham, NC, 27710, USA

    Carolyn L. Lekavich

  2. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Carolyn L. Lekavich, Debra J. Barksdale & Jia-Rong Wu

  3. Biobehavioral Laboratory, School of Nursing, University of North Carolina, Chapel Hill, NC, USA

    Virginia Neelon

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  3. Virginia Neelon
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Correspondence to Carolyn L. Lekavich.

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Dr. Lekavich has no conflicts of interest to report and previously served on the Speaker’s Bureau for Pfizer Pharmaceuticals. Dr. Barksdale has no conflicts of interest to report and is current member of the Board of Governors of the Patient Centered Outcomes Research Institute (PCORI). Drs. Neelon and Wu have no conflicts of interest to report.

Appendix A

Appendix A

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Table 1 List of abbreviations (alphabetically)
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Lekavich, C.L., Barksdale, D.J., Neelon, V. et al. Heart failure preserved ejection fraction (HFpEF): an integrated and strategic review. Heart Fail Rev 20, 643–653 (2015). https://doi.org/10.1007/s10741-015-9506-7

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  • DOI: https://doi.org/10.1007/s10741-015-9506-7

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