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Pharmacological strategies in heart failure with preserved ejection fraction: time for an individualised treatment strategy?
  1. Frédéric Schnell1,2,
  2. Erwan Donal1,3
  1. 1 INSERM UMR 1099, Rennes, France
  2. 2 Department of Physiology, Rennes1 University, Rennes, France
  3. 3 Department of Cardiology, Pontchaillou Hospital, Rennes, France
  1. Correspondence to Dr Erwan Donal, Department of Cardiology, CHU Rennes, 35033 Rennes, France; erwan.donal{at}

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Heart failure (with preserved ejection fraction (HFpEF) is a major global health issue. Indeed, with the ageing of the population, its prevalence is growing, affecting between 1.1% and 5.5% of the global population, and accounting for 50% of HF cases.

HFpEF: a difficult diagnosis

HFpEF is a complex clinical syndrome with a large variety of phenotypes. Its definition is not simple, with no gold standard, making the diagnosis sometimes challenging for the clinician, and explaining therefore the heterogeneity of patients included in the different studies. HFpEF is characterised by symptoms and signs of HF associated with a normal or nearly normal left ventricular ejection fraction. The definition of ‘preserved’ ejection fraction (EF) in previous clinical trials was not homogeneous, with cut-off values varying from 40% to 50%. The latest European Society of Cardiology (ESC) guidelines have chosen a cut-off value of ≥50% and have created a new category called HF with mid-range ejection fraction. In order to establish the diagnosis, these guidelines also require the presence of elevated natriuretic peptides and objective evidence of other cardiac functional and structural alteration underlying HF (left atrial enlargement or left ventricular hypertrophy). …

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  • Contributors FS and ED worked together on the manuscript. The quantify of work was identical between them.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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