Table 2

Comparison between HFrEF and HFpEF

Ponikowski et al 67
Risk factors
Mentz et al 68
Metra and Teerlink69
  • Male gender

  • Smoking

  • Hypercholesterolaemia

  • Hypertension

  • Diabetes

  • Obesity

  • A familial history of heart failure

  • A predisposition to cardiomyopathies

  • Exposure to cardiotoxic agents

  • Age

  • Female gender

  • Hypertension

  • Diabetes

  • Obesity

  • Renal dysfunction

  • Chronic obstructive pulmonary disease

  • Anaemia

Organ level
Katz and Rolett70
Eccentric LV remodellingConcentric LV remodelling
Cardiomyocyte level
van Heerebeek et al 71
  • Long and thin cardiomyocyte

  • Reduced myofibrillar density

  • Short and fat cardiomyocyte

  • Collagen deposition

Molecular level
Studer et al 26
van Heerebeek et al 71
Hamdani et al 72
Tanaka et al 73
Mishra et al 74
  • Decreased SERCA2a activity

  • Increased NCX activity

  • Increased SR Ca2+ leak

  • Titin shift to compliant N2BA isoform

  • Decreased SERCA2a activity

  • Reduced NCX activity

  • Increased SR Ca2+ leak

  • Titin shift to stiff N2B isoform

  • Titin hypophosphorylation

Metra and Teerlink69
Paulus and Tschöpe 75
Ferrari et al 76
Neurohormonal activationOne hypothesis is myocardial microvascular inflammatory endothelial activation (remains highly debated)
  • HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; LV, left ventricular; LVEF, left ventricular ejection fraction; NCX, Na+/Ca2+ exchange; SERCA2a, sarcoplasmic/endoplasmic reticulum calcium ATPase 2a; SR, sarcoplasmic reticulum.