IJCS | Volume 31, Nº6, November / December 2018

657 Table 1 - Example of therapeutic strategies for different phenotypes of heart failure with preserved ejection fraction Lung congestion + Chronotropic incompetence + Pulmonary hypertension + Skeletal muscle weakness + Atrial fibrillation Overweight/ Obesity/ Metabolic syndrome/ Type 2 DM . Diuretics (loop diuretics in DM) . Caloric restriction . Statin . Nitrate/Inorganic nitrite . Sacubitril . Spironolactone + Atrial pacemaker + Avoid betablockers and cardioselective calcium channel blockers + Pulmonary vasodilator + Anticoagulation (in PTE) + Exercise program + Cardioversion + Control of HR + Anticoagulation + SAH + ACEI/ARB + Calcium channel antagonist + ACEI/ARB + Atrial pacemaker + ACEI/ARB + Pulmonary vasodilator + ACEI/ARB + Exercise program + ACEI/ARB + Cardioversion + Control of HR + Anticoagulation + Kidney dysfunction + Ultrafiltration if necessary + nephroprotective drugs (ACEI/ARB) + Ultrafiltration if necessary + Atrial pacemaker + Ultrafiltration if necessary + Pulmonary vasodilator + Ultrafiltration if necessary + Exercise program + Ultrafiltration if necessary + Cardioversion + Control of HR + Anticoagulation + CAD + ACEI + Myocardial revascularization + ACEI + Revascularization + Atrial pacemaker + ACEI + Revascularization + Pulmonary vasodilator + ACEI + Revascularization + Exercise program + ACEI + Revascularization + Cardioversion + Control of HR + Anticoagulation Adapted from: Shah SJ, Kitzman DW, Borlaug BA, van Heerebeek L, Zile MR, Kass DA, Paulus WJ. Phenotype-specific treatment of heart failure with preserved ejection fraction: a multiorgan roadmap. Circulation. 2016;134(1):73-90. DM: diabetes mellitus; SAH: systemic arterial hypertension; CAD: chronic artery disease; ACEI: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blocker; PTE: pulmonary thromboembolism; HR: heart rate Figure 2 - The process towards effective therapies of heart failure with preserved ejection fraction: HFPEF: heart failure with preserved ejection fraction. HFPEF: a complex syndrome Understanding its pathophysiology Subdividing the syndrome into clinical phenotypes Inferring new therapeutic targets New clinical trials Individualized therapeutic approach Mesquita et al. HFPEF phenotypes Int J Cardiovasc Sci. 2018;31(6)652-661 Review Article diseases was found to mimic their phenotypic features. We found that this concept may be extended to HFPEF. Due to the heterogeneity nature of HFPEF, other diseases may have the same clinical phenotype and thereby be considered their “phenocopies”. Although both therapeutic intervention and prognosis of the diseases are different, their similar clinical presentation hampers the differential diagnosis. One pertinent example of a disease that mimics the clinical pattern of HFPEF is cardiac amyloidosis. 44,45 Cardiac amyloidosis is a restrictive cardiomyopathy, regardless of its type, characterized by progressive diastolic dysfunction followed by systolic dysfunction and arrhythmia. It may be first identified as exercise intolerance or HF. The diagnosis of cardiac amyloidosis is usually established in the late stages of the disease, since the disease affects the same elderly population affected by HFPEF. However, the exact contribution of amyloidosis to HFPEF has not been elucidated. Protein accumulation leads to asymptomatic left ventricular