Heart failure with preserved ejection fraction: Clinical characteristics of 4133 patients enrolled in the I‐PRESERVE trial

McMurray, John J.V.; Carson, Peter E.; Komajda, Michel; McKelvie, Robert S.; Zile, Michael R.; Ptaszynska, Agata; Staiger, C; Donovan, Jackie; Massie, Barry M.

doi:10.1016/j.ejheart.2007.12.010

Cited by 188 publications

(135 citation statements)

References 39 publications

(85 reference statements)

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“…Several other factors might have confounded the results of the I-PRESERVE trial including high rate of drug discontinuation (40%), concomitant use of ACEIs in the control arm (29%) and possible inclusion of patients without heart failure with symptoms being attributable to other factors (e.g. obesity) given that many patients had normal NT-proBNP levels (25th percentile for NT-proBNP was 139 and 131 pg/ml in the irbesartan and the placebo groups respectively) [143]. Because of these uncertainties, the guidelines give a weak recommendation (Class IIb, LOE: C) for the use of ACEIs or ARBs in HFpEF beyond control of blood pressure mentioning that they ''might be effective to minimize symptoms of heart failure'' [8].…”

Section: Aceis and Arbsmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction

Čulić

2017

N Engl J Med

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Heart failure with preserved ejection fraction (HFpEF) has recently emerged as a major cause of cardiovascular morbidity and mortality. Contrary to initial beliefs, HFpEF is now known to be as common as heart failure with reduced ejection fraction (HFrEF) and carries an unacceptably high mortality rate. With a prevalence that has been steadily rising over the past two decades, it is very likely that HFpEF will represent the dominant heart failure phenotype over the coming few years. The scarcity of trials in this semi-discrete form of heart failure and lack of unified enrolment criteria in the studies conducted to date might have contributed to the current absence of specific therapies. Understanding the epidemiological, pathophysiological and molecular differences (and similarities) between these two forms of heart failure is cornerstone to the development of targeted therapies. Carefully designed studies that adhere to unified diagnostic criteria with the recruitment of appropriate controls and adoption of practical end-points are urgently needed to help identify effective treatment strategies.

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Section: Aceis and Arbsmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction

Čulić

2017

N Engl J Med

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“…The prevalence of arterial hypertension in HFpEF patients amounts approximately 60-88% [1,[86][87][88][89]. The risk of developing HF after adjusting for age and other risk factors is approximately 2-fold higher in hypertensive men and 3-fold higher in hypertensive women than in normotensive persons [90].…”

Section: Hypertensionmentioning

confidence: 99%

“…In the Valsartan in Diastolic Dysfunction (VALIDD) trial only 3% of hypertensives had significant LV hypertrophy despite all having diastolic LV dysfunction [96]. In all HFpEF registries and large outcome trials [2,18,89], arterial hypertension in HFpEF consists of elevated systolic pressure (±148 mmHg) but normal diastolic pressure (±83 mmHg). In HFpEF, LV cavity dimensions are small and especially in the presence of LV hypertrophy, the LV operates at a favorable Laplace relationship.…”

Section: Hypertensionmentioning

confidence: 99%

“…HFpEF patients demonstrate a high prevalence of obesity and DM type II (DMII) [18][19][20][21]89]. Obesity and DMII are strongly related to IR and the metabolic syndrome (a constellation of cardiovascular risk factors, including obesity, hypertension, IR, hyperglycemia, dyslipidemia, microalbuminuria and hypercoagulability) [107,108].…”

Section: Metabolic Risk Factorsmentioning

confidence: 99%

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Impact of Comorbidities on Myocardial Remodeling and Dysfunction In Heart Failure with Preserved Ejection Fraction

Heerebeek

Paulus²

2014

SOJPPS

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“…59 Electrocardiograph, chest x-ray, and lung function Pleural effusions on a chest radiograph 60 are seen more frequently in LHD (although they may be present in severe PAH). Left-axis deviation and LV hypertrophy on an electrocardiograph are more often seen in HF-pEF, 61 whereas patients with advanced PAH tend to show evidence of R-wave dominance in V1, right-axis deviation, and more RV strain. 50,62 Also, end-tidal CO 2 63 and TLCO 4 have been found to be lower in patients with PAH than in those with PH and HF-pEF.…”

Section: Risk Factorsmentioning

confidence: 99%

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

et al. 2016

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Abstract:The most common cause of pulmonary hypertension (PH) due to left heart disease (LHD) was previously rheumatic mitral valve disease. However, with the disappearance of rheumatic fever and an aging population, nonvalvular LHD is now the most common cause of group 2 PH in the developed world. In this review, we examine the challenge of investigating patients who have PH and heart failure with preserved ejection fraction (HF-pEF), where differentiating between pulmonary arterial hypertension (PAH) and PH-LHD can be difficult, and also discuss the entity of combined precapillary and postcapillary PH. Given the proven efficacy of targeted therapy for the treatment of PAH, there is increasing interest in whether these treatments may benefit selected patients with PH associated with HF-pEF, and we review current trial data.Keywords: pulmonary arterial hypertension, combined pre-and postcapillary pulmonary hypertension, heart failure with preserved ejection fraction, diastolic dysfunction. (Table 1) by a mean pulmonary arterial pressure (PAP) of ≥25 mmHg at right heart catheterization (RHC), with the most recent classification identifying 5 groups (Fig. 1): 2 group 1, pulmonary arterial hypertension (PAH), which can be idiopathic (IPAH) or associated with other conditions (most frequently systemic sclerosis and congenital heart disease); group 2, PH owing to left heart disease (PH-LHD); group 3, PH owing to lung disease (PH-Lung); group 4, chronic thromboembolic PH (CTEPH); and group 5, PH owing to unclear or multifactorial mechanisms. Accurate classification of disease is important in identifying the most appropriate form of therapy 3 and defining prognosis. 4 This requires a systematic approach to the evaluation of the breathless patient and an awareness of conditions associated with particular forms of PH. Pulmonary hypertension (PH) is definedThe most commonly encountered form of PH is related to left heart disease (LHD). 5,6 PH may be seen in heart failure with preserved ejection fraction (HF-pEF) and heart failure with reduced ejection fraction (HF-rEF), and its presence in HF-rEF is known to convey a poor prognosis. 7 HF-pEF accounts for approximately half of all new heart failure (HF) diagnoses. 8,9 While HF-pEF was initially believed to confer a better outcome than HF-rEF, the two conditions have equivalent morbidity and mortality. [10][11][12] The prevalence of PH-HF-pEF is unclear and varies with diagnostic criteria. Studies quote rates of between 53% and 83% (based on an echocardiographic systolic PAP [sPAP] > 35 mmHg or mean PAP > 25 mmHg at RHC). 13-15 A recent study 16 found that only 7% of heart failure (HF) patients had PH (but used an sPAP cutoff of ≥45 mmHg at echocardiography). PATHOPHYSIOLOGY OF PH-LHDPAH, PH-Lung, and CTEPH are precapillary in nature, caused by obstruction or destruction of the pulmonary arterial bed, whereas PH-LHD is thought to be primarily due to postcapillary abnormalities. 5 In patients with LHD, an increase in left ventricular (LV) and left atrial (LA) filling pressu...

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Heart failure with preserved ejection fraction: Clinical characteristics of 4133 patients enrolled in the I‐PRESERVE trial

Cited by 188 publications

References 39 publications

Heart Failure with Preserved Ejection Fraction

Heart Failure with Preserved Ejection Fraction

Impact of Comorbidities on Myocardial Remodeling and Dysfunction In Heart Failure with Preserved Ejection Fraction

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

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