Does Secondary HFpEF Exist? Yes, but it Should not be Called HFpEF

Introduction

Heart failure with preserved ejection fraction (HFpEF) is defined as a syndrome with symptoms and signs of heart failure (HF) and left ventricular ejection fraction (LVEF) ≥ 50%. This simplistic definition may lead to diagnostic errors by mistaking non-cardiac diseases for HFpEF. The European Society of Cardiology (ESC) offers a more comprehensive definition HFpEF, which requires the presence of symptoms and signs of HF, along with evidence of structural and/or functional cardiac abnormalities, and/or elevated natriuretic peptides, with an LVEF ≥ 50%.

The pathophysiology of HFpEF is not fully understood. Still, it is generally considered a heterogenous and systemic syndrome associated with inflammation, aging, genetic predisposition, and multiple comorbidities, such as hypertension, diabetes mellitus, obesity, and atrial fibrillation. The disease ultimately progresses to loss of left ventricular relaxation, left atrial remodeling, and signs of congestion.

[…]