Heart failure with normal ejection fraction. Pathophysiology, diagnosis, and treatment.

Symptoms of heart failure are documented in patients, in a manner independent of their current ejection fraction (EF). Today, about 50% of all heart failure patients have a normal EF (HFNEF) and their outcome regarding mortality and morbidity is as severe as in patients with reduced EF. Nevertheless, the awareness of this disease is still limited. Furthermore, the diagnostic criteria are still a challenge in the daily clinical setting. Here, the recent recommendations of the European Society of Cardiology (ESC) on how to diagnose HFNEF will be reviewed. Moreover, the recent pathologic understanding will be discussed as well, because alongside noncardiac reasons for HFNEF, diastolic as well as nondiastolic abnormalities are known to be important for the development of HFNEF. Treatment options will be reviewed including the recent clinical trials for this group of patients.