What is Heart Failure with Preserved Ejection Fraction (HFpEF)?

John Vitarello MD
2 min readAug 14, 2023

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Heart failure with preserved ejection fraction (HFpEF, pronounced hef-pef) also known as diastolic heart disease, is a cardiovascular condition characterized by the inability of the heart to effectively pump blood while maintaining a relatively normal ejection fraction. Ejection fraction refers to the percentage of blood pumped out of the heart’s left ventricle during each contraction.

In HFpEF the heart’s ability to relax and fill with blood during its relaxation phase (diastole) is impaired, leading to inadequate blood flow to meet the body’s demands. For this reason, HFpEF is often referred to as a “stiff heart.”

This results in symptoms of heart failure, such as fatigue, shortness of breath, and swelling of the legs. Unlike heart failure with reduced ejection fraction (HFrEF), where the heart’s pumping ability is significantly diminished, in HFpEF, the ejection fraction remains relatively normal (typically greater than 50%). Ejection fraction is measured with an ultrasound of the heart (echocardiogram) or by MRI.

Despite advances in cardiac imaging, the diagnosis of HFpEF remains a challenge. This leads to patients with heart failure to be misdiagnosed or experience a delay in their diagnosis.

The pathophysiology of HFpEF is multifaceted and not fully understood, but it is commonly associated with various factors including older age, diabetes, hypertension, and obesity. With an aging population and increasing rates of obesity and diabetes, the number of Americans with HFpEF is growing.

Treatment for HFpEF focuses on modifying lifestyle, medications, managing symptoms with diuretics, and treatment of the risk factors themselves (e.g. controlling high blood pressure).

Bottom Line:

Heart failure with preserved ejection fraction (HFpEF) also known as diastolic heart disease, is impairment of the pump function of the heart. Symptoms include shortness of breath and swelling of the legs. Diagnosis of HFpEF is made with an echocardiogram.

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John Vitarello MD

Cardiology Fellow @ UVA Medical Center. Creating fast reads on important Cardiology topics with a focus on prevention