# Diastolic Dysfunction in Acute and Critical Illness: Acute Pathophysiology to Chronic Heart Failure

## TL;DR

This paper explores how acute diastolic dysfunction in critical illness can lead to chronic heart failure and reviews new treatments and diagnostics for heart failure with preserved ejection fraction.

## Contribution

The paper provides a comprehensive review of the pathophysiology and treatment of acute and chronic heart failure with preserved ejection fraction.

## Key findings

- Acute HFpEF is a systemic inflammatory syndrome driven by comorbidities.
- New therapies like SGLT2i and GLP-1 RAs are transforming HFpEF care.
- AI-driven diagnostics are improving the management of HFpEF.

## Abstract

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous, multi-organ syndrome driven by comorbidity-induced systemic inflammation. In acute and critical illness, such as sepsis, acute diastolic dysfunction is common. Its prognostic significance is debated and is complicated by hemodynamic instability and diagnostic challenges.

Survivors of acute illness face a long-term risk of major adverse cardiovascular events, yet the transition from critical illness to acquired diastolic dysfunction to chronic HFpEF remains an underexplored area requiring further research.

Recent landmark trials have established new therapeutic options for chronic HFpEF, including sodium glucose co-transporter 2 inhibitors, mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists. Here, we review the pathophysiology of HFpEF across the continuum from chronic stable HFpEF to acute decompensation, identify long-term sequelae, and highlight future advancements.

•Acute HFpEF is a systemic inflammatory syndrome driven by comorbidities, extending beyond the myocardium.•In critical illness, acute diastolic dysfunction is common, but its link to mortality is complex.•New therapies (SGLT2i, GLP-1 RAs) and AI-driven diagnostics are revolutionizing HFpEF care.

Acute HFpEF is a systemic inflammatory syndrome driven by comorbidities, extending beyond the myocardium.

In critical illness, acute diastolic dysfunction is common, but its link to mortality is complex.

New therapies (SGLT2i, GLP-1 RAs) and AI-driven diagnostics are revolutionizing HFpEF care.