Myocardial Tissue Characterization in Heart Failure with Preserved Ejection Fraction: From Histopathology and Cardiac Magnetic Resonance Findings to Therapeutic Targets

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome responsible for high mortality and morbidity rates. It has an ever growing social and economic impact and a deeper knowledge of molecular and pathophysiological basis is essential for the ideal management of HFpEF patients. The association between HFpEF and traditional cardiovascular risk factors is known. However, myocardial alterations, as well as pathophysiological mechanisms involved are not completely defined. Under the definition of HFpEF there is a wide spectrum of different myocardial structural alterations. Myocardial hypertrophy and fibrosis, coronary microvascular dysfunction, oxidative stress and inflammation are only some of the main pathological detectable processes. Furthermore, there is a lack of effective pharmacological targets to improve HFpEF patients’ outcomes and risk factors control is the primary and unique approach to treat those patients. Myocardial tissue characterization, through invasive and non-invasive techniques, such as endomyocardial biopsy and cardiac magnetic resonance respectively, may represent the starting point to understand the genetic, molecular and pathophysiological mechanisms underlying this complex syndrome. The correlation between histopathological findings and imaging aspects may be the future challenge for the earlier and large-scale HFpEF diagnosis, in order to plan a specific and effective treatment able to modify the disease’s natural course.

Clinical Support through Telemedicine in Heart Failure Outpatients during the COVID-19 Pandemic Period: Results of a 12-Months Follow Up

“…A significant proportion of heart failure with reduced ejection fraction (HFrEF) patients have cardiovascular implantable electronic devices (CIED), compared to HFpEF patients, who are much more rarely invasively telemonitored. HFpEF patients are an aged population with high mortality and hospitalization rates, representing an ever-growing population in the HF spectrum [ 36 , 37 ]. For these reasons, telemedicine approaches through telephone consultations or other external devices may be particularly beneficial for HFpEF patients.…”

Do the Current Guidelines for Heart Failure Diagnosis and Treatment Fit with Clinical Complexity?

“…Despite a normal LVEF, this patient has a low cardiac output, and his prognosis is related to several consequences, such as renal impairment and respiratory infections. In fact, the term preserved ejection fraction seems reassuring, but it hides energetic, structural and functional heart abnormalities [23,24]. Of note, LVEF-based classification it is not closely related to HF prognosis, and often, HFpEF patients show worse outcomes than HFrEF's group, with increased mortality and hospitalisation [10].…”

Mitochondrial dysfunction in heart failure and its therapeutic implications

“…Recent study found that intensive sympatho-excitation leads to pathological cardiac hypertrophy and fibrosis, which is coupled with decreased UPRmt and increased mitochondrial proteotoxic stress ( 80 ). These myocardial morphological alterations is closely associated with heart failure with preserved ejection fraction (HFpEF) ( 81 ). Smyrnias et al demonstrated that UPRmt is activated during chronic pressure overload and pharmacological enhancement of the UPRmt alleviates mitochondrial and contractile dysfunction in the stressed heart ( 82 ).…”