What is the primary difference in systolic function between HFrEF and HFpEF?

• A. HFpEF has reduced LV ejection fraction indicating systolic dysfunction.
• B. HFrEF has preserved EF with diastolic dysfunction.
• C. HFrEF has reduced LV ejection fraction indicating systolic dysfunction.
• D. Both have reduced EF.

Answer: (C)

The key idea is that systolic function is about the heart’s ability to contract and pump blood, which is measured by the ejection fraction (EF). In HFrEF, the heart’s pumping strength is reduced, so the LV ejection fraction is lowered (typically less than about 40%), reflecting systolic dysfunction. In HFpEF, the ejection fraction is preserved, and the problem lies with the ventricle’s ability to relax and fill (diastolic dysfunction). Therefore, the statement that best captures the primary difference is that HFrEF has reduced LV ejection fraction indicating systolic dysfunction, whereas HFpEF has preserved EF with diastolic dysfunction. The other options mix up whether EF is reduced or preserved and misstate which dysfunction is predominant.