Vasodilators Across the Heart Failure Spectrum

The term heart failure with preserved ejection fraction (HFpEF) has evolved to describe the broad clinical syndrome characterized by signs and symptoms of heart failure in patients in whom the ejection fraction (EF) falls within the low normal to normal range. This terminology is essentially descriptive, and implies neither etiology nor pathophysiology, although both continue to fuel vigorous debate. One of the most fundamental of these debates has been whether HFpEF is a truly distinct pathophysiologic entity from heart failure with reduced ejection fraction (HFrEF). While most would agree that the etiologic conditions that lead to heart failure differ between these 2 groups in the majority of cases, whether the pathophysiologic derangements that underlie the nearly identical signs and symptoms are also different at either end of the heart failure spectrum remains unclear.