Heart failure with preserved ejection fraction

Liu, Yingwei; Haddad, Tony; Dwivedi, Girish

doi:10.1097/hco.0b013e32835c5492

Cited by 21 publications

(33 citation statements)

References 81 publications

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“…Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT), a large trial of spironolactone (N=3445) in more symptomatic, advanced HFpEF is still in progress [3]. Better understanding of pathophysiology of HFpEF has identified new drug targets [64]. A small trial with a short follow-up period showed significant improvement in pulmonary pressure, right ventricular function, and LV relaxation and distensibility with the use of sildenafil in HFpEF patients who had evidence of superimposed PAH [65].…”

Section: Lesson #8: It Is Possible To Treat Hfpef—treat Now By Treatimentioning

confidence: 99%

Diagnosis and Management of Heart Failure with Preserved Ejection Fraction: 10 Key Lessons

Oktay¹,

Shah

2014

CCR

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Heart failure with preserved ejection fraction (HFpEF) is a common clinical syndrome associated with high rates of morbidity and mortality. Due to the lack of evidence-based therapies and increasing prevalence of HFpEF, clinicians are often confronted with these patients and yet have little guidance on how to effectively diagnose and manage them. Here we offer 10 key lessons to assist with the care of patients with HFpEF: (1) Know the difference between diastolic dysfunction, diastolic heart failure, and HFpEF; (2) diagnosing HFpEF is challenging, so be thorough and consider invasive hemodynamic testing to confirm the diagnosis; (3) a normal B-type natriuretic peptide does not exclude the diagnosis of HFpEF; (4) elevated pulmonary artery systolic pressure on echocardiography in the presence of a normal ejection fraction should prompt consideration of HFpEF; (5) use dynamic testing in evaluating the possibility of HFpEF in patients with unexplained dyspnea or exercise tolerance; (6) all patients with HFpEF should be systematically evaluated for the presence of coronary artery disease; (7) use targeted treatment for HFpEF patients based on their phenotypic classification; (8) treat HFpEF patients now by treating their comorbidities; (9) understand the importance of heart rate in HFpEFlower is not always better; and (10) do not forget to consider rare diseases ("zebras") as causes for HFpEF when evaluating and treating patients. Taken together, these 10 key lessons can help clinicians care for challenging patients with HFpEF while we eagerly await the results of ongoing HFpEF clinical trials and observational studies.

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Section: Lesson #8: It Is Possible To Treat Hfpef—treat Now By Treatimentioning

confidence: 99%

Diagnosis and Management of Heart Failure with Preserved Ejection Fraction: 10 Key Lessons

Oktay¹,

Shah

2014

CCR

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“…1–3 HF has historically been attributed to systolic dysfunction, as evidenced by a LV ejection fraction of ≤ 45%. This HF phenotype is now referred to as HF with reduced ejection fraction (HFrEF) and is characterized by a progressive ventricular dilation.…”

Section: Introductionmentioning

confidence: 99%

“…1 In contrast to HFrEF, individuals with HFpEF generally are older, more likely to be female, and have a lower incidence of coronary artery disease but greater occurrence of atrial fibrillation. 3 A leading cause of HFpEF is hypertension, and the sine qua non of HFpEF is diastolic dysfunction or impaired relaxation of the LV. Although both forms of HF occur at similar prevalences, HFpEF is increasing at a steady rate and is anticipated to become the most common type of HF in the next 10 years.…”

Section: Introductionmentioning

confidence: 99%

“…Although both forms of HF occur at similar prevalences, HFpEF is increasing at a steady rate and is anticipated to become the most common type of HF in the next 10 years. 3 Individuals with HFpEF exhibit a higher number of noncardiac comorbidities, including diabetes, obesity, peptic ulcer disease, cancer, chronic obstructive pulmonary disease, psychiatric disorders, and anemia. 3 The pattern of concentric cardiac remodeling seen in HFpEF, coupled with prolonged relaxation times, is commonly observed in the elderly irrespective of the presence of HF.…”

Section: Introductionmentioning

confidence: 99%

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Heart Failure with Preserved Ejection Fraction

Zouein

Brás²,

Costa³

et al. 2013

Journal of Cardiovascular Pharmacology

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Approximately half of heart failure patients have a normal ejection fraction, a condition designated as heart failure with preserved ejection fraction (HFpEF). This heart failure subtype disproportionately affects women and the elderly and is commonly associated with other cardiovascular comorbidities, such as hypertension and diabetes. HFpEF is increasing at a steady rate and is predicted to become the leading cause of heart failure within a decade. HFpEF is characterized by impaired diastolic function, thought to be due to concentric remodeling of the heart along with increased stiffness of both the extracellular matrix and myofilaments. In addition, oxidative stress and inflammation are thought to have a role in HFpEF progression, along with endothelial dysfunction and impaired nitric oxide-cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG) signaling. Surprisingly a number of clinical studies have failed to demonstrate any benefit of drugs effective in heart failure with systolic dysfunction in HFpEF patients. Thus, HFpEF is one of the largest unmet needs in cardiovascular medicine and there is a substantial need for new therapeutic approaches and strategies that target mechanisms specific for HFpEF. This conclusion is underscored by the recently reported disappointing results of the RELAX trial, which assessed the use of phosphodiesterase-5 inhibitor sildenafil for treating HFpEF. In animal models, endothelial nitric oxide synthase (eNOS) activators and If current inhibitors have shown benefit in improving diastolic function and there is a rationale for assessing matrix metalloproteinase-9 (MMP-9) inhibitors and nitroxyl donors. LCZ696, a combination drug of angiotensin II receptor blocker and neprilysin inhibitor, and the aldosterone receptor antagonist spironolactone are currently in clinical trial for treating HFpEF. Here we present an overview of the etiology and diagnosis of HFpEF that segues into a discussion of new therapeutic approaches emerging from basic research, as well as drugs currently in clinical trial, that primarily target diastolic dysfunction or imbalanced ventricular-arterial coupling.

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“…This condition of HF with preserved ejection fraction (HFpEF) is thought to be more common in women and more prevalent in the elderly, with similar mortality rates as HFrEF (12–15). HFpEF is documented as the leading cause of hospital admission in patients over 65 years of age and is predicted to be the leading cause of HF within a decade (16, 17). Notably, HFpEF is a leading cause of pulmonary hypertension (HTN) (18).…”

Section: Introductionmentioning

confidence: 99%

Targeting Obesity and Diabetes to Treat Heart Failure with Preserved Ejection Fraction

et al. 2017

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Heart failure with preserved ejection fraction (HFpEF) is a major unmet medical need that is characterized by the presence of multiple cardiovascular and non-cardiovascular comorbidities. Foremost among these comorbidities are obesity and diabetes, which are not only risk factors for the development of HFpEF, but worsen symptoms and outcome. Coronary microvascular inflammation with endothelial dysfunction is a common denominator among HFpEF, obesity, and diabetes that likely explains at least in part the etiology of HFpEF and its synergistic relationship with obesity and diabetes. Thus, pharmacological strategies to supplement nitric oxide and subsequent cyclic guanosine monophosphate (cGMP)—protein kinase G (PKG) signaling may have therapeutic promise. Other potential approaches include exercise and lifestyle modifications, as well as targeting endothelial cell mineralocorticoid receptors, non-coding RNAs, sodium glucose transporter 2 inhibitors, and enhancers of natriuretic peptide protective NO-independent cGMP-initiated and alternative signaling, such as LCZ696 and phosphodiesterase-9 inhibitors. Additionally, understanding the role of adipokines in HFpEF may lead to new treatments. Identifying novel drug targets based on the shared underlying microvascular disease process may improve the quality of life and lifespan of those afflicted with both HFpEF and obesity or diabetes, or even prevent its occurrence.

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Heart failure with preserved ejection fraction

Cited by 21 publications

References 81 publications

Diagnosis and Management of Heart Failure with Preserved Ejection Fraction: 10 Key Lessons

Diagnosis and Management of Heart Failure with Preserved Ejection Fraction: 10 Key Lessons

Heart Failure with Preserved Ejection Fraction

Targeting Obesity and Diabetes to Treat Heart Failure with Preserved Ejection Fraction

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