Fluid Overload in Heart Failure with Preserved Ejection Fraction (HFpEF)

Pathophysiology and Clinical Manifestations

• The American College of Cardiology defines HFpEF as heart failure with an ejection fraction ≥50%, representing approximately half of all heart failure cases, with diastolic dysfunction as the primary issue 1, 3
• Diastolic dysfunction causes increased left ventricular stiffness and impaired relaxation, leading to elevated filling pressures even with normal contractility, as noted by the American Heart Association 2, 3
• The European Society of Cardiology reports that elevated filling pressures are transmitted backward to the pulmonary circulation, causing pulmonary congestion and dyspnea 4
• Increased left ventricular wall thickness and reduced chamber compliance limit diastolic filling, according to the American College of Cardiology 1, 5
• Structural abnormalities include left ventricular hypertrophy and increased extracellular matrix deposition, as stated by the European Heart Journal 1, 6

Diagnostic Evaluation and Management

• Echocardiographic evidence of diastolic dysfunction with preserved ejection fraction (≥50%) is a key diagnostic criterion, as recommended by the American College of Cardiology 1, 5
• The European Society of Cardiology suggests that an elevated E/e' ratio (>14) on echocardiography indicates increased left ventricular filling pressures 8, 9
• Diuretics remain the cornerstone of treatment for fluid overload in HFpEF, according to the American Journal of Kidney Diseases 7
• The American College of Cardiology recommends treatment of contributing comorbidities (hypertension, diabetes, obesity, atrial fibrillation) as essential for managing HFpEF 6