Heart failure with preserved ejection fraction in women: the Dutch Queen of Hearts program

Abstract

Heart failure (HF) poses a heavy burden on patients, their families and society. The syndrome of HF comes in two types: with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The latter is on the increase and predominantly present in women, especially the older ones. There is an urgent need for mortality-reducing drugs in HFpEF, a disease affecting around 5 % of those aged 65 years and over. HFpEF develops in patients with risk factors and comorbidities such as obesity, hypertension, diabetes, COPD, but also preeclampsia. These conditions are likely to drive microvascular disease with involvement of the coronary microvasculature, which may eventually evolve into HFpEF. Currently, the diagnosis of HFPEF relies mainly on echocardiography. There are no biomarkers that can help diagnose female microvascular disease or facilitate the diagnosis of (early stages of) HFpEF. Recently a Dutch consortium was initiated, Queen of Hearts, with support from the Netherlands Heart Foundation, with the aim to discover and validate biomarkers for diastolic dysfunction and HFpEF in women. These biomarkers come from innovative blood-derived sources such as extracellular vesicles and circulating cells. Within the Queen of Hearts consortium, we will pursue female biomarkers that have the potential for further evolution in assays with point of care capabilities. As a spin-off, the consortium will gain knowledge on gender-specific pathology of HFpEF, possibly opening up novel treatment options.

The prognostic value of highly sensitive cardiac troponin assays for adverse events in men and women with stable heart failure and a preserved vs. reduced ejection fraction

“…Plasma concentrations of cardiac troponins are known to be higher in men than in women within the general population, although the underlying factors responsible for the presence of, and gender differences in, circulating troponins in apparently healthy individuals remain obscure. 20 HFpEF is known to have a higher prevalence in women compared with men, occurring at a ratio of 2.1, 21 which was also seen in our population. The cause of this inter-gender difference remains unknown.…”

Transcriptome and Functional Profile of Cardiac Myocytes Is Influenced by Biological Sex

“…These results are particularly interesting considering that women are more likely to develop heart failure with preserved ejection fraction (HFpEF), which is characterized by left ventricular diastolic dysfunction and stiffness. 31 The prolonged relaxation times we observed in female cardiac myocytes and myofibrils at baseline, in combination with aging, may provide the underlying mechanism that predisposes women to developing HFpEF, but more focused researched on this observation is required.…”

Mast Cell Inhibition Attenuates Cardiac Remodeling and Diastolic Dysfunction in Middle-aged, Ovariectomized Fischer 344 × Brown Norway Rats

“…The percentage of LV fractional shortening (FS), an index of contractile function, was calculated as FS (%) = [(LVEDD - LVESD) / LVEDD] × 100. LV mass was calculated using a standard cube formula, which assumes a spherical LV geometry according to the formula: LV mass = 1.04 × [(LVEDD + PWT + AWT) 3 - LVEDD], where 1.04 is the specific gravity of muscle. Relative wall thickness (RWT) was calculated as: 2 × PWT / LVEDD.…”

“…Also, women are approximately two times more likely than men to develop heart failure in the setting of HFpEF. 3,4 In contrast to heart failure with reduced ejection fraction (HFrEF), there are no proven effective pharmacotherapies for HFpEF. 1,2,5 Understanding the mechanisms underlying HFpEF in older women is critical for the development of effective interventions to limit and treat this healthcare problem.…”