Fisiopatologia e Tratamento da Insuficiência Cardíaca com Fra??o de Eje??o Preservada: Estado da Arte e Perspectivas para o Futuro

摘要

Heart failure (HF) is extremely prevalent and has a considerable impact on mortality and quality of life.1 It affects nearly 1-3% of the adult population in developed countries, exponentially increasing with age and affecting more than 10% of the population over 70 years. Given the increase in the average life expectancy, better diagnostic methods and increased comorbidities, a greater prevalence of heart failure is expected.2 It is a clinical syndrome characterized by classic symptoms (such as fatigue, dyspnea) that may be accompanied by clinical signs (elevated jugular pressure, pulmonary crackles and peripheral edema). It is caused by structural and/or functional cardiac abnormalities, resulting in reduced cardiac output and/or elevated intracardiac pressures at rest or during stress.3 The main terminology used to describe HF is based on the measurement of the left ventricular ejection fraction (EF), differentiating patients with reduced 40% (HFrEF), mid-range 40-49% (HFmrEF) and preserved ≥50% (HFpEF) ejection fraction. This classification is important due to different underlying etiologies, pathophysiology, available treatment and its respective response.3 HFpEF accounts for about half of the cases of HF in developed countries.