Literature review of a novel heart failure paradigm: differences between heart failure with preserved ejection fraction and heart failure with a reduced ejection fraction

Greta Gujytė1, Laura Norkutė1

1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania


Heart failure (HF) is a chronic progressive multietiology syndrome, affecting approximately 2 % of Western adult population and is more common in the elderly age group (up to 5-9 %) for people over the age of 65 and the numbers are still increasing. This multifactorial syndrome is associated with many activations of neurohormonal compensatory mechanisms that have not been fully elucidated yet. HF has different phenotypes, which in recent years are associated with systemic proinflammatory state induced by comorbidities. Also, in the last few years, more and more research is emerging to support the theory of chronic systemic inflammation and the occurrence of inflammatory conditions in different groups of HF as the cause of structural and functional myocardial changes at the molecular and cellular level.

Aim: to analyze scientific literature and provide a review of literature related to new aspects of heart failure pathogenesis.

Methods: literature review and data collection sources were selected from ClinicalKey, ScienceDirect, SpringerLink, Wiley Online Library, PubMed and Cochrane Library scientific databases, following dates from 2016 to 2021, using original language keywords: “heart failure pathophysiology”, “inflammation in heart failure”, “heart failure phenotypes”, “heart failure with preserved ejection fraction pathogenesis”, “gender-related differences in heart failure”. Exclusion criteria: young adults, active infections, chronic conditions directly related to inflammation, acute heart failure and other acute pathologies of target organs, congenital heart disease, clinical trials of drugs in heart failure patients.

Conclusion:  the etiological and pathogenic factors of heart failure with preserved ejection fraction are not fully known. The etiology of both preserved and reduced ejection fraction in HF groups is inflammation-related, but due to its difference in targets, myocardial remodel in different ways.

Keywords: chronic heart failure pathophysiology, inflammation in heart failure, heart failure phenotypes, preserved ejection fraction pathogenesis, gender-related differences in heart failure.