Treatment of Heart Failure With Preserved Ejection Fraction: Have We Been Pursuing the Wrong Paradigm? Gerard O. Oghlakian, MD, Ilke Sipahi, MD, James.

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Treatment of Heart Failure With Preserved Ejection Fraction: Have We Been Pursuing the Wrong Paradigm? Gerard O. Oghlakian, MD, Ilke Sipahi, MD, James C. Fang, MD Mayo Clinic Proceedings Volume 86, Issue 6, Pages 531-539 (June 2011) DOI: 10.4065/mcp.2010.0841 Copyright © 2011 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Mode of death of patients in trials of heart failure with preserved ejection fraction. Left, I-PRESERVE = Irbesartan in Heart Failure with Preserved Ejection Fraction Study. Right, CHARM-Preserved = Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity. Data from Circulation.10 Mayo Clinic Proceedings 2011 86, 531-539DOI: (10.4065/mcp.2010.0841) Copyright © 2011 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Criteria to diagnose heart failure with normal left ventricular ejection fraction (HFNEF), referred to as heart failure with preserved ejection fraction in the current study, as per the consensus statement by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Ad = duration of mitral valve atrial wave flow; Ard = duration of reverse pulmonary vein atrial systole flow; b = constant of left ventricular chamber stiffness; BNP = brain natriuretic peptide; DT = deceleration time; E = early mitral valve flow velocity; E′= early TD lengthening velocity; E/A = ratio of early (E) to late (A) mitral valve flow velocity; LAVI = left atrial volume index; LVEDP = left ventricular end-diastolic pressure; Echo = echocardiography; LVEDVI = left ventricular end-diastolic volume index; LVEF = left ventricular ejection fraction; LVMI = left ventricular mass index; mPCW = mean pulmonary capillary wedge pressure; NT-proBNP = N-terminal pro-brain natriuretic peptide; τ = time constant of left ventricular relaxation; TD = tissue Doppler. From Eur Heart J,11 with permission. Mayo Clinic Proceedings 2011 86, 531-539DOI: (10.4065/mcp.2010.0841) Copyright © 2011 Mayo Foundation for Medical Education and Research Terms and Conditions