Maintaining Success for Patients With Dilated Cardiomyopathy and Remission of Heart Failure

Halliday, Brian P; Cleland, John G.F.

doi:10.1016/j.jacbts.2022.03.008

Cited by 2 publications

(4 citation statements)

References 6 publications

(7 reference statements)

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“…dilated cardiomyopathy) who receive guideline-recommended therapy; this should not be considered HFpEF but rather HF with recovered LVEF. 6 , 7 For patients with HFpEF, LVEF may also drop over time due to measurement error [increased with the onset of atrial fibrillation (AF)] 8 or additional myocardial insults (e.g. myocardial infarction).…”

Section: Introductionmentioning

confidence: 99%

Inflammatory pathways in heart failure with preserved left ventricular ejection fraction: implications for future interventions

Pugliese

Pellicori

Filidei

et al. 2022

Cardiovascular Research

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Many patients with symptoms and signs of heart failure have a left ventricular ejection fraction ≥50%, termed heart failure with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous syndrome mainly affecting older people who have many other cardiac and non-cardiac conditions that often cast doubt on the origin of symptoms, such as breathlessness, or signs, such as peripheral oedema, rendering them neither sensitive nor specific to the diagnosis of HFpEF. Currently, management of HFpEF is mainly directed at controlling symptoms and treating comorbid conditions such as hypertension, atrial fibrillation, anaemia and coronary artery disease. HFpEF is also characterised by a persistent increase in inflammatory biomarkers. Inflammation may be a key driver of the development and progression of HFpEF and many of its associated comorbidities. Detailed characterisation of specific inflammatory pathways may provide insights into the pathophysiology of HFpEF and guide its future management. There is growing interest in novel therapies specifically designed to target deregulated inflammation in many therapeutic areas, including cardiovascular disease. However, large-scale clinical trials investigating the effectiveness of anti-inflammatory treatments in HFpEF are still lacking. In this manuscript, we review the role of inflammation in HFpEF and the possible implications for future trials.

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Section: Introductionmentioning

confidence: 99%

Inflammatory pathways in heart failure with preserved left ventricular ejection fraction: implications for future interventions

Pugliese

Pellicori

Filidei

et al. 2022

Cardiovascular Research

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“…Secondly, the LVEF may deteriorate again, further supporting that in a substantial proportion of patients with normalized LVEF, there is a state of remission (HFrEFrem) rather than true permanent recovery [ 5 , 6 , 15 – 17 ]. Taken together, it appears that LVEF normalization does not reflect a return to the normal state but the transition to a lesser state of disease [ 3 ].…”

Section: The Continuum Of Improving Lvef: Understanding the Lvef Traj...mentioning

confidence: 99%

“…Dilated cardiomyopathy results from a wide range of genetic and acquired causes [ 7 ]. An interaction between genetic predisposition and environmental factors may apply in a significant proportion of patients (“seed and soil” hypothesis, first used by Stephen Paget in 1889 to describe cancer metastasis) [ 5 ]. The underlying processes contributing to disease likely impact the rate and degree of LVRR and the future risk of relapse.…”

Section: How Can Disease Etiology and Underlying Disease Activity Inf...mentioning

confidence: 99%

“…Interest in this patient group has driven the creation of new subcategories of HF (Table 1 ). There is currently an agreement that HF with improved EF (HFimpEF) includes patients with a previous LVEF ≤ 40% that increases to > 40%, typically with the contribution of guideline-directed medical therapy (GDMT) and device therapy [ 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Your Heart Function Has Normalized—What Next After TRED-HF?

Kasiakogias,

Ragavan,

Halliday

2023

Curr Heart Fail Rep

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Purpose of Review With the widespread implementation of contemporary disease-modifying heart failure therapy, the rates of normalization of ejection fraction are continuously increasing. The TRED-HF trial confirmed that heart failure remission rather than complete recovery is typical in patients with dilated cardiomyopathy who respond to therapy. The present review outlines key points related to the management and knowledge gaps of this growing patient group, focusing on patients with non-ischaemic dilated cardiomyopathy. Recent Findings There is substantial heterogeneity among patients with normalized ejection fraction. The specific etiology is likely to affect the outcome, although a multiple-hit phenotype is frequent and may not be identified without comprehensive characterization. A monogenic or polygenic genetic susceptibility is common. Ongoing pathophysiological processes may be unraveled with advanced cardiac imaging, biomarkers, multi-omics, and machine learning technologies. There are limited studies that have investigated the withdrawal of specific heart failure therapies in these patients. Diuretics may be safely withdrawn if there is no evidence of congestion, while continued therapy with at least some disease-modifying therapy is likely to be required to reduce myocardial workload and sustain remission for the vast majority. Summary Understanding the underlying disease mechanisms of patients with normalized ejection fraction is crucial in identifying markers of myocardial relapse and guiding individualized therapy in the future. Ongoing clinical trials should inform personalized approaches to therapy.

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Maintaining Success for Patients With Dilated Cardiomyopathy and Remission of Heart Failure

Cited by 2 publications

References 6 publications

Inflammatory pathways in heart failure with preserved left ventricular ejection fraction: implications for future interventions

Inflammatory pathways in heart failure with preserved left ventricular ejection fraction: implications for future interventions

Your Heart Function Has Normalized—What Next After TRED-HF?

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