The pursuit of understanding Heart Failure with preserved Ejection Fraction (HFpEF)

Heart failure is a complex and chronic condition with varying causes. Until about 10 years ago, heart failure was always associated with an impaired pumping function resulting in an oxygen deficiency of the myocardial, high blood pressure, arrhythmias or leaking valves. All research was carried out on this patient population. Today, heart failure with reduced pumping function can be treated with multiple medications and devices which result in clear improvement such as reduced symptoms, improved quality of life and reduced mortality. In recent years, it has become known that 50% of all patients with heart failure do not have a reduced pumping function. These patients have various structural or functional abnormalities in the heart as a result of, or that cause, increased pressure in the left ventricle. The most accepted theory says that comorbidities such as obesity, high blood pressure, diabetes, iron deficiency, COPD or sleep apnoea cause low-grade systemic inflammation that affects all the body's small vessels. As a result, the disease affects the small blood vessels of the myocardial, resulting in reduced oxygen supply to the heart muscle, but also to other organs such as the muscles or kidneys. To date, no effective therapy for Heart Failure with Preserved Ejection Fraction (HFpEF) has been found. This has to do with various factors, but in particular with the way in which the classical studies are carried out. The heterogeneity of this disease most likely means that different patient groups with different comorbidities react differently to the same therapy.