Breakthrough Concept in Hfpef

Heart failure with preserved ejection fraction (HFPEF), a clinical syndrome where heart failure (HF) exists in the presence of normal or near-normal left ventricular ejection fraction (LVEF), accounts for up to half of all HF patients. However, in contrast to heart failure with reduced ejection fraction (HFREF), where therapeutic advances have significantly improved outcomes over the last two decades, there has been little progress in the development of effective, evidence-based therapies for HFPEF. Guideline recommendations for the management of HFPEF have been unchanged for a decade and empirical, largely confined to the use of diuretics and treatment of comorbidities [1,2]. Disappointing results from large phase III HFPEF clinical trials, including the Irbesartan in Heart Failure with Preserved Ejection Fraction Study (I-PRESERVE) [3], Perindopril for Elderly People with Chronic Heart Failure (PEP-CHF) [4], Candersartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity-Preserved Study (CHARM-Preserved) [5], and Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) [6], underscore our incomplete understanding of this disease. At the same time, HFPEF is becoming the predominant form of HF in aging societies [7], and represents a huge public health burden worldwide. Clearly, a breakthrough is urgently needed to address what is increasingly recognized as the largest unmet need in cardiology today—HFPEF.