The Puzzle of Heart Failure With Preserved Ejection Fraction

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Presentation transcript:

The Puzzle of Heart Failure With Preserved Ejection Fraction Daniel José Piñeiro Full Professor of Medicine, Universidad de Buenos Aires, Argentina Board Member, World Heart Federation Former President, Interamerican Society of Cardiology, and Argentine Society of Cardiology

I have nothing to disclose Disclosure I have nothing to disclose

1. Is Dyspnea Sufficient to Diagnose HFpEF?

Deconditioning/Intolerance to Exercise ≠ HFpEF

≤ 40 % ≥ 50% 41-49 > 40 HFrEF HFpEF HFpEF, borderline HFpEF, improved ≤ 40 % ≥ 50% 41-49 > 40 Yancy C. J Am Coll Cardiol. 2013;62:e147-239

LVEF < 40% LVEF 40-49% LVEF ≥ 50% Type of HF HFrEF HFmrEF HFpEF CRITERIA 1 Symptoms ± Signs 2 LVEF < 40% LVEF 40-49% LVEF ≥ 50% 3 --- BNP ↑ At least one additional criterion: Relevant structural heart disease (LVH/LAE) Diastolic dysfunction Ponikowski P. Eur Heart J. 2016;37:2129-200

2. Is HFpEF Frequent?

Owan T. N Engl J Med. 2006;355:251-9

3. Can We Die of HFpEF?

Brouwers F. Eur Heart J. 2013;34:1424-31

4. Does HFpEF Have a Single Biopathology?

Borlaug B. Circ J. 2014;78:20-32

5. Can We Improve Diagnosis, Prognosis, and Treatment?

Andersen. J Am Coll Cardiol. 2017;69:1937-48

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

D'Elia E. Eur J Heart Fail. 2015;17:1231-9

Conclusions

The Puzzle of HFpEF Is dyspnea sufficient to diagnose HFpEF? NO Is HFpEF frequent? YES Can we die of HFpEF? YES Does HFpEF have a single biopathology? NO Can we improve diagnosis, prognosis and treatment? YES???

The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn. Toffler A. (1928-1916)

Thank you!!!