Heart failure with preserved ejection fraction update: A review of clinical trials and new therapeutic considerations

Abstract

Between 2013 and 2016 there were approximately 6.2 million adults in the United States living with heart failure; nearly half had an ejection fraction that was preserved. Despite the high prevalence of heart failure with preserved ejection fraction (HFpEF), our understanding of this disease is limited and it still carries significant morbidity and mortality worldwide. At present, physicians are burdened by the inconclusive benefits of currently available treatment options. Recently the scientific community has seen an influx of new pathophysiology studies and outcome trials that have reshaped our understanding of HFpEF as a complex, multi-systemic disease. Pharmacological trials involving beta-blockers, angiotensin II receptor antagonists, aldosterone antagonists, and angiotensin-neprilysin inhibitors have demonstrated encouraging results, but have yet to reach the significance of advancements made in the treatment of heart failure with reduced ejection fraction. This review aims to summarize landmark clinical trials that have influenced current treatment guidelines, and reports on emerging evidence supporting/ refuting new treatment modalities including pharmacotherapy, lifestyle modification and device therapy.

A Review of Sodium-Glucose Cotransporter 2 Inhibitor’s Clinical Efficacy in Heart Failure With Preserved Ejection Fraction

“…Consistent results were observed when mortality analyses were restricted to patients enrolled in cardiovascular outcome trials. Empagliflozin emerged as superior in improving survival, while prospective head-to-head comparisons are warranted to validate these findings [ 6 , 7 , 11 , 14 ].…”

“…Table 1 summarizes the literature mentioned in the paragraphs above [ 2 , 3 , 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

“…Elevated pulmonary vascular pressures often result in right heart dysfunction. This predisposes patients to adverse outcomes via venous congestion [ 5 , 6 ].…”

“…Additionally, vascular abnormalities such as peripheral vascular disease and endothelial dysfunction, along with decreased nitric oxide levels seen in HFpEF, contribute to greater afterload and increased end-systolic volume (ESV). Although rare, infiltrative cardiomyopathies such as amyloidosis are estimated to affect roughly 15-20% of HFpEF patients [ 6 , 7 ].…”

Heart failure with preserved ejection fraction: A mini review

“…In addition, hypertension treatment, use of SGLT2i, and lifestyle changes such as weight loss, dietary approach, physical activity, and cardiorespiratory itness may reduce the incidence of HFpEF [8]. On the other hand, the use of left atrial assist device (LAAD) realized by transcatheter implantation of an interatrial shunt device (IASD) to increase aortic pression and decrease LA pressure in keeping arterial pulsatility, although promising, needs further studies [9].…”