HFpEF, a Disease of the Vasculature: A Closer Look at the Other Half

Lyle, Melissa; Brozovich, Frank V.

doi:10.1016/j.mayocp.2018.05.001

Cited by 48 publications

(44 citation statements)

References 58 publications

(105 reference statements)

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“…Diastolic intracellular calcium handling is a major determinant of LV relaxation. Dephosphorylated phospholamban (PLN) is an inhibitor of sarcoplasmic/endoplasmic reticulum Ca(2+)ATPase 2a (SERCA2a), but PKA-catalyzed (or CaMKII) phosphorylation of PLN results in the dissociation of PLN from SERCA2a, thus activating this Ca 2+ pump and augmenting SERCA2a activity (9,10). Cardiomyocyte Ca 2+ accumulation in the absence of concomitant enhancement of SERCA activity leads to elevated diastolic Ca 2+ , Ca 2+ transients with preserved or enhanced amplitude, and slower Ca 2+ reuptake kinetics with impaired relaxation.…”

Section: Diastolic Limitationsmentioning

confidence: 99%

Heart failure with preserved ejection fraction: an update on pathophysiology, diagnosis, treatment, and prognosis

Luo

Fan

et al. 2020

Braz J Med Biol Res

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Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF with normal or near-normal left ventricular ejection fraction (LVEF X50%). Roughly half of all patients with HF worldwide have an LVEF X50% and nearly half have an LVEF o50%. Thanks to the increased scientific attention about the condition and improved characterization and diagnostic tools, the incidence of HF with reduced ejection fraction (HFrEF) dropped while that of HFpEF has increased by 45%. HFpEF has no single guideline for diagnosis or treatment, the patient population is heterogeneously and inconsistently described, and longitudinal studies are lacking. To better understand and overcome the disease, in this review, we updated the latest knowledge of HFpEF pathophysiology, introduced the existing promising diagnostic methods and treatments, and summarized its prognosis by reviewing the most recent cohort studies.

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Section: Diastolic Limitationsmentioning

confidence: 99%

Heart failure with preserved ejection fraction: an update on pathophysiology, diagnosis, treatment, and prognosis

Luo

Fan

et al. 2020

Braz J Med Biol Res

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“…Chronic maladaptive neurohumoral activation leading to sustained systemic arterial hypertension has been implicated in the course of HFpEF [ 54 ]. Studies have shown that systemic hypertension is a critical determinant of outcome in HFpEF as it plays a crucial role in the onset and maintenance of a proinflammatory state, arterial stiffness, ventricular hypertrophy, titin-dependent stiffness, and dysfunction [ 55 – 57 ]. In patients with HFpEF, control of hypertension can induce regression of myocardial mass and improve cardiac function and relaxation as well as clinical outcomes [ 58 , 59 ].…”

Section: Hfpef and Hypertensionmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction—a Concise Review

et al. 2020

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Purpose of Review Heart failure with preserved ejection fraction (HFpEF) is a relatively new disease entity used in medical terminology; however, both the number of patients and its clinical significance are growing. HFpEF used to be seen as a mild condition; however, the symptoms and quality of life of the patients are comparable to those with reduced ejection fraction. The disease is much more complex than previously thought. In this article, information surrounding the etiology, diagnosis, prognosis, and possible therapeutic options of HFpEF are reviewed and summarized. Recent Findings It has recently been proposed that heart failure (HF) is rather a heterogeneous syndrome with a spectrum of overlapping and distinct characteristics. HFpEF itself can be distilled into different phenotypes based on the underlying biology. The etiological factors of HFpEF are unclear; however, systemic low-grade inflammation and microvascular damage as a consequence of comorbidities associated with endothelial dysfunction, oxidative stress, myocardial remodeling, and fibrosis are considered to play a crucial role in the pathogenesis of a disease. The H 2 FPEF score and the HFpEF nomogram are recently validated highly sensitive tools employed for risk assessment of subclinical heart failure. Summary Despite numerous studies, there is still no evidence-based pharmacotherapy for HFpEF and the mortality and morbidity associated with HFpEF remain high. A better understanding of the etiological factors, the impact of comorbidities, the phenotypes of the disease, and implementation of machine learning algorithms may play a key role in the development of future therapeutic strategies.

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“…The underlying causes of HFpEF, including hypertension, type 2 diabetes, and coronary artery disease, first damage the most susceptible longitudinally arranged subendocardial myocardial fibers, which lead to impairment of longitudinal function . A previous study also demonstrated that longitudinal function plays a key role in LV myocardial performance and global function in patients with HF .…”

Section: Discussionmentioning

confidence: 98%

Left ventricular systolic dysfunction potentially contributes to the symptoms in heart failure with preserved ejection fraction

et al. 2019

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Aims Left ventricular diastolic dysfunction (LVDD) is considered a key factor associated with heart failure (HF) symptoms in patients with preserved ejection fraction (HFpEF). However, LV systolic performance, including LV systolic function and synchrony, has not been well characterized in these patients. The aims of this study were to assess to investigate the underlying relationship and differences between subclinical LVDD and HFpEF. Methods Eighty‐six patients with LVDD were recruited (58 with HFpEF and 28 with subclinical LVDD). Systolic left ventricular (LV) longitudinal strain (LS), systolic longitudinal strain rate (LSrS), early diastolic longitudinal strain rate (LSrE), and late diastolic longitudinal strain rate (LSrA) were measured using speckle tracking echocardiography. LV diastolic and systolic dyssynchrony (Te‐SD and Ts‐SD) were calculated. Forty age‐ and sex‐matched healthy individuals were enrolled as a control group. Results LV global LS and LSrS were decreased in patients with HFpEF than in normal controls and subclinical LVDD patients (P < .05). Te‐SD and Ts‐SD were significantly more prolonged in subclinical LVDD and HFpEF patients than in the control group (P < .05). Reduced LS was associated with HF symptoms in LVDD patients, and a cutoff value of −18% for LS could differentiate HFpEF from subclinical LVDD with 73% sensitivity and 69% specificity. Conclusion LV systolic function and mechanical dyssynchrony were impaired in HFpEF patients. Deteriorated LV longitudinal systolic function was likely correlated with the symptoms of HFpEF.

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HFpEF, a Disease of the Vasculature: A Closer Look at the Other Half

Cited by 48 publications

References 58 publications

Heart failure with preserved ejection fraction: an update on pathophysiology, diagnosis, treatment, and prognosis

Heart failure with preserved ejection fraction: an update on pathophysiology, diagnosis, treatment, and prognosis

Heart Failure with Preserved Ejection Fraction—a Concise Review

Left ventricular systolic dysfunction potentially contributes to the symptoms in heart failure with preserved ejection fraction

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