A. Left ventricle
B. Left atrium in isolation
C. Both left ventricle & left atrium
D. Isolated right ventricle failure.
E. It is actually a Bi-Ventricular failure.
Trying to answer
If any one can answer this question, correctly , he deserves some award. I am yet to find an answer.
HFpEF , by its definition has Normal EF, diastolic LV failure , LA reservoir dysfunction, combined post and pre cap PHT, with or without RV failure.
Full blown HFpEF has some what curious hemodynmics. Though we expect LA to fail in isolatiin, it is the right ventricle, that over works to tackle the elevated LAP and PH . Hence, it is likely clinical RV failure would be more common than LV.
Therorticaly, we can say , HFpEF is typical example of Bi ventricular failure as well, ie LV diastolic ,and RV systolic failure. If you want to be still more precise, it should be called triple chamber failure (LV,LA & RV)
Final message.
HFpEF continues to be complex clinical entity, with no single chamber is a primary culprit. It is a multi chamber failure. In fact, the failure initiating chamber may play lesser role than the responding chamber may react disproportionately. Please Note : LA is failure defining chamber. If it can tackle the stiff LV with all its might (compliance and contractility) , no other chamber need to fail.
Dr.S.Venkatesan MD 