What is the Difference Between HFpEF and HFrEF?

The main difference between HFpEF (heart failure with preserved ejection fraction) and HFrEF (heart failure with reduced ejection fraction) lies in the left ventricular ejection fraction (LVEF) and the underlying pathophysiologic processes. Here are the key differences:

1. Definition: HFpEF is typically defined as heart failure with an LVEF of 50% or greater, while HFrEF is heart failure with an LVEF of less than 40%.
2. Pathophysiology: HFpEF is characterized by structural and cellular alterations, including cardiomyocyte hypertrophy, fibrosis, and inflammation, leading to an inability of the left ventricle to relax properly. In contrast, HFrEF is characterized by substantial cardiomyocyte loss, resulting in the development of systolic dysfunction, or the inability of the left ventricle to contract properly.
3. Comorbidities: Patients with HFpEF often have comorbidities such as hypertension, type 2 diabetes mellitus, obesity, and renal insufficiency, while patients with HFrEF may share some of these risk factors but have different responses to therapies.
4. Treatment: The treatment of patients with HFpEF and HFrEF differs as there is no standard of care for HFpEF at the moment. Treatment for HFpEF is often empirical, focusing on reducing congestion with diuretics, while treatment for HFrEF follows more established guidelines.

In summary, the main differences between HFpEF and HFrEF are the LVEF values, the underlying pathophysiologic processes, the comorbidities, and the treatment approaches.

Comparative Table: HFpEF vs HFrEF

Heart failure (HF) can be classified into two main types based on the ejection fraction (EF): heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Here is a table summarizing the differences between HFrEF and HFpEF:

In summary, HFrEF is characterized by a reduced ejection fraction and is due to the left ventricle's inability to contract properly, while HFpEF is characterized by a preserved ejection fraction and is due to the left ventricle's inability to relax properly.