Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure that affects the left side of the heart. It occurs when the lower left chamber of the heart, called the left ventricle, is unable to relax and fill with blood in the normal way.
People may also refer to HFpEF as diastolic failure or diastolic dysfunction.
This article looks at HFpEF in more detail, including its symptoms, causes, and treatment.
HFpEF is a type of left-sided heart failure. Left-sided heart failure occurs when the left ventricle does not function as it should. Another type is heart failure with reduced ejection fraction (HFrEF), in which the heart is unable to pump blood effectively.
The function of the left ventricle is to pump oxygenated blood to the rest of the body. It is larger than the other chambers of the heart, as it is responsible for most of the pumping action of the heart.
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As a result, the heart is unable to fill with blood properly during the resting periods between heartbeats. As the blood continues to enter the left ventricle after each heartbeat, this can lead to higher blood pressure in this chamber.
Ejection fraction is a measure of how well the heart is pumping blood. Doctors give the score as a percentage.
Doctors use ejection fraction percentages to categorize left-sided heart failure. According to a 2022 article, people with HFpEF have an ejection fraction of
HFpEF affects about 50% of all people with heart failure. In the United States, there are 6.6 million cases of heart failure each year, almost half of which are HFpEF.
The symptoms of HFpEF may include:
- shortness of breath
- swelling in the lower legs
- swelling in the abdominal area
- physical intolerance to exercise
- fatigue
Other possible symptoms of left-sided heart failure
- breathing that feels uncomfortable or more difficult when lying down
- shortness of breath at night that wakes people from sleeping
- weight gain
- liver congestion, which can cause pain in the upper right abdomen
Left-sided heart failure may occur
- chronic or uncontrolled high blood pressure
- coronary artery disease
- heart arrhythmias
Risk factors specifically for HFpEF
- atrial fibrillation, which is a condition that causes an irregular and fast heartbeat
- diabetes
- chronic kidney disease
- older age
- having obesity or a high body mass index (BMI)
- smoking
- chronic obstructive pulmonary disease
To treat HFpEF, doctors will focus on treating the underlying cause or any factors that may be contributing to HFpEF. This may
- controlling blood pressure levels
- managing arrhythmias
- restoring blood flow into any blocked blood vessels
- taking antimineralocorticoid drugs, which help the kidneys move excess fluid and salt out of the body
Doctors may use the following criteria to diagnose heart failure:
| Major criteria | Minor criteria |
|---|---|
| • excess fluid in the lungs • an enlarged heart • pressure on the liver causes swelling of the neck veins • shortness of breath when lying down | • swelling in the ankles • shortness of breath during activity • an enlarged liver • a cough at nighttime • fluid buildup around the lungs • heart rate above 120 beats per minute |
A person will only receive a diagnosis of heart failure if they meet at least two major criteria or one major and two minor criteria.
To diagnose HFpEF in people with heart failure, doctors will also measure ejection fraction. An ejection fraction measurement
Doctors also look for the following indicators of HFpEF:
- a specific sound of the heart, called the S3 heart sound
- an abnormal pulse in the chest, called the apical pulse
- the bulging of veins in the neck
As part of the diagnostic process for HFpEF, doctors may carry out the
- a physical assessment
- a natriuretic peptide test, which is a blood test to measure substances that the heart makes, with high levels indicating that the heart is not pumping as effectively as normal
- a metabolic panel, which is a blood test to check sodium levels, as low levels may indicate heart problems
- liver function tests
- EKG, which measures the electrical activity of the heart
- an echocardiogram, which uses ultrasound to create an image of the heart and helps measure ejection fraction to differentiate between HFpEF and HFrEF
- a coronary angiogram, which uses an X-ray and special dye to create an image of the heart’s blood vessels
Outcomes can vary for each individual and may depend on which other health conditions are present.
Almost 50% of hospitalizations for heart failure in the U.S. are due to HFpEF.
HFpEF has a mortality rate of more than 50% at 5 years following hospitalization. However, HFpEF may have a
Factors that may worsen the outlook for people with heart failure include:
- older age
- being male
- very low blood pressure
- kidney failure
- elevated heart rate
- low ejection fraction
Managing blood pressure, staying physically active, eating a nutritious diet, and controlling risk factors such as diabetes and diseases of the arteries
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People will need to contact a doctor if they experience any of the following symptoms:
- shortness of breath
- swelling in the lower legs or abdomen
- fatigue
- intolerance to exercise
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- a frequent, dry, hacking cough
- feeling short of breath when resting
- swelling or discomfort in the lower body
- sudden weight gain of more than 2–3 pounds in a 24-hour period or of 5 pounds in a week
- new or worsening state of confusion, dizziness, depression, or sadness
- loss of appetite
- difficulty breathing when lying flat
Anyone who experiences any of the above will need to seek medical attention straight away.
HFpEF is a type of heart failure in which the left ventricle is unable to relax and fill with blood as normal. It is a common type of heart failure, accounting for about half of all heart failure cases.
The treatment for HFpEF may vary for each individual, but it can include managing blood pressure, taking medications, and making lifestyle adjustments.