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J Cardiol. 2013 Jul;62(1):1-3. doi: 10.1016/j.jjcc.2013.02.017. Epub 2013 May 11.

Heart failure: what does ejection fraction have to do with it?

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  • 1Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1045, USA.


Heart failure (HF) occurs across the entire range of left ventricular (LV) ejection fractions (EF), not just reduced EF. Nearly half or more patients presenting with HF have a preserved EF>0.50 (HFpEF). Diastolic dysfunction is apparent in all patients with HF, regardless of EF. A preserved EF indicates that the end-diastolic volume is appropriate for the stroke volume, and a reduced EF indicates that the end-diastolic volume is enlarged relative to stroke volume (i.e. the LV is dilated). Most therapies proven to be effective in HF with a reduced EF (ACE-inhibitors, angiotensin receptor blockers, beta-blockers, and cardiac resynchronization) reverse LV dilation. These therapies have not been proven to be effective in HFpEF. Increasing c-GMP may be a treatment target in HFpEF, and potential ways of increasing c-GMP are being studied. Finally, comorbidities are important in HFpEF and are additional targets for therapy.

Copyright © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.


Ejection fraction; Heart failure; Heart failure with preserved ejection fraction

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