Study Background and Disease Burden
Heart failure with preserved ejection fraction (HFpEF) constitutes nearly half of heart failure (HF) cases globally and primarily affects elderly populations. Unlike heart failure with reduced ejection fraction (HFrEF), HFpEF is characterized by a baseline left ventricular ejection fraction (LVEF) equal to or greater than 50%. Despite normal or near-normal systolic function, patients with HFpEF suffer from significant morbidity and mortality due to a complex pathophysiology involving diastolic dysfunction, myocardial stiffness, systemic inflammation, and comorbidities.
Sudden cardiac death (SCD) and ventricular tachyarrhythmias are recognized fatal complications traditionally linked to HFrEF. However, in HFpEF, the role of LVEF changes over time as a predictor of lethal arrhythmias and mortality has been insufficiently studied. While baseline LVEF is a known marker for risk stratification in HF, the prognostic significance of a longitudinal decline in LVEF among HFpEF patients remains unclear. Understanding this relationship is critical, given that LVEF decline may indicate disease progression toward a more adverse phenotype, necessitating altered management strategies.
