The key difference between HFpEF and HFrEF is that HFpEF (heart failure with preserved ejection fraction) takes place when the left ventricle fails to fill properly during diastolic phase while HFrEF (heart failure with reduced ejection fraction) takes place when the heart muscles fail to squeeze properly to pump an adequate amount of oxygen-rich blood to other parts of the body during systolic phase.
Ejection fraction tells how much blood is being pumped by the left ventricle during each contraction. It is a measurement that can reveal your heart condition and helps to diagnose heart failures. Diastolic heart failure or HFpEF and systolic heart failure or HFrEF are two types of heart failures related to ejection fraction. When the left ventricle fails to fill properly during diastole, HFpEF occurs. When the left ventricle fails to pump an adequate amount of oxygen-rich blood to the body during systole, HFrEF occurs. Healthier range of ejection fraction is between 50 to 70%. If it is higher than 75%, it indicates hypertrophic cardiomyopathy. If it ranges from 40 to 49%, it indicates the development of heart failure. In severe heart failures, ejection fraction goes below 40%.
CONTENTS
1. Overview and Key Difference
2. What is HFpEF
3. What is HFrEF
4. Similarities Between HFpEF and HFrEF
5. Side by Side Comparison – HFpEF vs HFrEF in Tabular Form
6. Summary
What is HFpEF?
Diastolic heart failure or heart failure with preserved ejection fraction (HFpEF) is a type of heart failure which occurs due to insufficient filling of the left ventricle with blood. Here, the ventricle does not relax properly. This may be due to the stiffness of the muscles. As a result, the ventricular filling does not occur correctly. In other words, the left ventricle is not able to fill with blood properly during the diastole. As a result, the amount of blood pumped out the left ventricle is less than the normal value. When left ventricle does not fill properly, the heart increases the pressure inside the ventricle to compensate for it. With time, this increased filling causes blood to build up inside the left atrium and eventually into the lungs. In the end, it shows fluid congestion and symptoms of heart failure. Coronary artery disease, high blood pressure, aortic stenosis, hypertrophic cardiomyopathy and pericardial disease are major causes of HFpEF.
Figure 01: Thickening of Left Ventricular Muscles
What is HFrEF?
Systolic heart failure or heart failure with reduced ejection fraction (HFrEF) is a type of heart failure that occurs when the left ventricle fails to pump an adequate amount of oxygen-rich blood to the body. In simple words, the heart pumps less amount of purified blood than the amount your body needs. During systole, heart muscles contract and pump oxygenated blood to rest of the body tissues and organs. In each contraction, a fraction of the total blood in the left ventricle goes out. This fraction is known as ejection fraction. An ejection fraction of 55% means, 55% of the total blood in the left ventricle is pumped out in each contraction. The normal ejection fraction is more than 55%. Generally, it ranges from 50 to 70%. If this value is 40% or less, it indicates a systolic heart failure or HRfEF.
There are many causes of systolic heart failure. Heart attacks damage heart muscles, leading to heart failure. Coronary artery disease, high blood pressure, Mitral regurgitation, viral myocarditis and aortic stenosis are some other major cause of systolic heart failure. Patients with HFrEF can manage their low ejection fraction by limiting salt consumption, managing fluid intake and exercising regularly.
What are the Similarities Between HFpEF and HFrEF?
- HFpEF and HFrEF are two types of heart failures based on the ejection fraction.
- In both types, the amount of blood pumped out to the body is less than the normal.
- Two types are related to the left ventricle of the heart.
- Fatigue and shortness of breath are common symptoms of both HFpEF and HFrEF.
- Diabetes, hypertension, kidney diseases and obesity are common risk factors of both.
- Most importantly, both are not considered to be independent and separate entities.
What is the Difference Between HFpEF and HFrEF?
HFpEF is a type of heart failure that occurs due to the inability of the left ventricle to relax properly. HFrEF is a type of heart failure that occurs due to the inability of the left ventricle to contract properly. So, this is the key difference between HFpEF and HFrEF. Left ventricle fails to fill properly in HFpEF while the left ventricle fails to pump out an adequate amount of blood to the body in HFrEF. In HFpEF, ejection fraction is greater than 50% while in HFrEF, ejection fraction is lower than 40%. Moreover, HFpEF is predominant in females than males. HFrEF is predominant in males than females.
Below infographic tabulates side by side the differences between HFpEF and HFrEF.
Summary – HFpEF vs HFrEF
In heart failure, the heart fails to pump a sufficient amount of blood to meet the metabolic demand of the body. HFpEF (heart failure with preserved ejection fraction) takes place when the left ventricle fails to fill properly during diastolic phase while HFrEF (heart failure with reduced ejection fraction) takes place when the heart muscles fail to squeeze properly to pump an adequate amount of oxygen-rich blood to other parts of the body during systolic phase. Thus, this is the summary of the difference between HFpEF and HFrEF.
Reference:
1. “Heart Failure With Preserved Ejection Fraction (Diastolic Heart Failure).” Heart Failure With Preserved Ejection Fraction (Diastolic Heart Failure) | Michigan Medicine, Available here.
2. Simmonds, Steven J, et al. “Cellular and Molecular Differences between HFpEF and HFrEF: A Step Ahead in an Improved Pathological Understanding.” Cells, MDPI, 18 Jan. 2020, Available here.
Image Courtesy:
1. “Heart left ventricular hypertrophy sa” By Patrick J. Lynch, medical illustrator – Patrick J. Lynch, medical illustrator (CC BY 2.5) via Commons Wikimedia