Criteria for diagnosis of HFmrEF and HFpEF require evidence of increased LV filling pressures at rest and/or exercise. Additionally, patients may have elevated levels of natriuretic peptides, echocardiographic diastolic dysfunction parameters, evidence of structural heart disease such as increase in left atrial size and volume and/or an increase in LV mass.2
With diastolic dysfunction, the left ventricular wall is thickened and stiff, and it loses ability to relax as the ventricle fills. The poor filling function results in an increase of end-diastolic pressure in the left ventricle. This increases the left atrial pressure and volume and a build-up of pressure in the lungs. Patients then experience congestion and shortness of breath, along with other signs or symptoms of HF.
The heart’s limited ability to function over time, whether due to lack of pumping or filling, limits a patient’s ability to exercise or even to perform normal activities as the disease progresses over time.3