Heart failure with preserved EF is primarily due to what dysfunction?

• A. Systolic dysfunction
• B. Valvular regurgitation
• C. Right heart failure
• D. Diastolic dysfunction

Answer: (D)

Heart failure with preserved ejection fraction centers on diastolic dysfunction. In this condition, the ventricle is stiff and less compliant, often from hypertrophy or fibrosis, so it doesn’t relax well and fills inadequately during diastole. The result is higher filling pressures in the left atrium and pulmonary circulation, leading to symptoms of heart failure even though the left ventricular ejection fraction remains normal or near-normal. Because systolic contractility is preserved, it’s not primarily a problem of squeezing the heart, which is why systolic dysfunction isn’t the main issue. Valvular regurgitation or right-sided failure can occur in heart disease but don’t define HFpEF; the key feature is impaired relaxation and filling (diastolic dysfunction).