The Disscussion On The Progress Of The Diagnosis And Treatment Of The Heart Failure With Preserved Ejection Fraction

With going deep into basic and clinical researches, people found that some patients with typical symptoms of heart failure, the ejection fraction only slightly decreased or normal, we call it heart failure with preserved ejection fraction (HFPEF) which used to be called the diastolic heart failure. The incidence of HFPEF is about 50%(40%～71%) of the total number of patients with heart failure.The prognosis of HFPEF seems to be similar with the reduced ejection fraction (HFREF) which was thought to be more dangerous before. The pathogenesis of HFPEF include the injury of the active relaxation ability and impaired left ventricular stiffness, which is commonly seen in the elderly,female, diabetes, mellitus, hypertension, atrial fibrillation and part of patients with ischemic cardiomyopathy. The diagnostic criteria of HFPEF mainly includes:typical signs and symptoms of heart failure, left ventricular ejection fraction (LVEF) is between 45% and 50% or higher, and have evidence of left ventricular diastolic dysfunction.The diagnosis of HFPEF is a comprehensive evaluation combined with cardiac catheterization,echocardiography, NT-proBNP etc. At present, specialists consistently recommend that the gold standard of HFPEF is cardiac catheter which can measure to acquire the evidence of the diastolic dysfunction directly, but the application is not widely used as desired in clinic. Now the most widely used examinations of HFPEF are echocardiography and NT-proBNP which have been more well-known and certain internationally with the advantages of noninvasion, conveniention, good accuracy.The indexes of echocardiograpy consist mostly of mitral valve flow spectrum (MVF), tissue Doppler echocardiography (IDE), pulmonary venous flow spectrum (PVF), left atrial volume index (LAVI), left ventricularwall mass index (LVMI).Despite the large-scale clinical studies of DIG-PEF, CHARM-preserve-d and I-PRESERVE have been conducted, there is still an absence of standardized diagnosis and treatment process, the treatment of HFPEF which is lack of specificity seems to be more difficult than which of HFREF.The survival rate is not significantly improved with the traditional drugs which has good curative effection in HFREF. At present, specialists recommend that the best treatment options for HFPEF is overall treatment,and it’s necessary to seek a breakthrough in the patho genesis of HFPEF. Next we will mainly review some new concepts related to the left ventricular diastolic function to have a better understanding of the cardiovascular pathophysiology in HFPEF, discuss the application of echocardiog-raphy and NT-proBNP in the diagnosis of HFPEF. Besides,the development of the medication of HFPEF will be discussed as well.