Novel Mechanisms in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction

Lakhani, Ishan; Leung, Keith Sai Kit; Tse, Gary; Lee, Alex

doi:10.3389/fphys.2019.00874

Cited by 21 publications

(23 citation statements)

References 56 publications

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“…HFpEF is a clinical syndrome characterized by abnormal diastolic function, decreased compliance, and increased stiffness. The main mechanisms include left atrial hypertension, pulmonary hypertension (PH), plasma volume expansion, systemic microvascular inflammation, cardiometabolic functional abnormalities, and cellular (titin)/extracellular (fibrosis) structural abnormalities 3,4 . In addition, common characteristics of patients with HFpEF include advancing age, a higher body mass index (BMI), female gender, and atrial fibrillation (AF) but lower frequency of ischemic heart disease (IHD) 5 .…”

Section: Introductionmentioning

confidence: 99%

“…The main mechanisms include left atrial hypertension, pulmonary hypertension (PH), plasma volume expansion, systemic microvascular inflammation, cardiometabolic functional abnormalities, and cellular (titin)/extracellular (fibrosis) structural abnormalities. 3,4 In addition, common characteristics of patients with HFpEF include advancing age, a higher body mass index (BMI), female gender, and atrial fibrillation (AF) but lower frequency of ischemic heart disease (IHD). 5 Over the past few decades, the prevalence of HFpEF increased from 41% to 56%, whereas the prevalence of HFrEF and HFmrEF decreased from 44% to 31% and from 15% to 13%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Predictive value of H₂FPEF score in patients with heart failure with preserved ejection fraction

et al. 2021

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Aims The H 2 FPEF score is a convenient risk stratification tool for diagnosing heart failure with preserved ejection fraction (HFpEF). This study examined the value of the H 2 FPEF score for predicting all-cause mortality and rehospitalization in HFpEF patients. Methods and results This was a retrospective cohort study of patients diagnosed with HFpEF by echocardiography at a single tertiary centre between 1 January 2015 and 30 April 2018. According to the H 2 FPEF score, the subjects were divided into low (0-1 points), intermediate (2-5 points), and high (6-9 points) score groups. The primary outcomes were all-cause mortality and rehospitalization. A total of 476 patients (mean age: 70.5 ± 8.4 years, 60.7% female) were included. Of these, 47 (9.9%), 262 (55.0%), and 167 (35.1%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 27.5 months, 63 patients (13.2%) died, and 311 patients (65.3%) were rehospitalized. The mortality rates were 3 (6.4%), 29 (11.1%), and 31 (18.6%), and the number of patients with rehospitalization was 28 (59.6%), 159 (60.7%), and 124 (74.3%) for the low, intermediate, and high score groups, respectively. Multivariate Cox regression identified H 2 FPEF score as an independent predictor of all-cause mortality (hazard ratio [HR]: 1.46, 95% CI: 1.23-1.73, P < 0.0001) and rehospitalization (HR: 1.15, 95% CI: 1.08-1.22, P < 0.0001). Receiver operating characteristic (ROC) analysis demonstrated the H 2 FPEF score can effectively predict all-cause mortality (AUC 0.67, 95% CI: 0.60-0.73, P < 0.0001) and rehospitalization (AUC 0.59, 95% CI: 0.54-0.65, P = 0.001) after adjusting for age and NYHA class. With a cutoff value of 5.5, the sensitivity and specificity were 68.3% and 55.4% for all-cause mortality and 50.5% and 66.7% for rehospitalization. Conclusions The H 2 FPEF score can be used to predict prognosis in HFpEF patients. Higher scores are associated with higher all-cause mortality and rehospitalization.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictive value of H₂FPEF score in patients with heart failure with preserved ejection fraction

et al. 2021

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“…In the latest European Society of Cardiology (ESC) guideline, HF was divided into HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF) based on LVEF (7). HFmrEF patients are encountered with an increasing frequency in contemporary HF clinics (8). The latest data show that the prevalence of HFmrEF in hospitalized patients ranged from 13 to 26% (9)(10)(11), while the prevalence in outpatients varied from 9 to 21% (12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Zhang

Sun

Chen

et al. 2021

Front. Cardiovasc. Med.

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Aims: Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure with preserved ejection fraction (HFpEF) deteriorates or heart failure with reduced ejection fraction (HFrEF) improves. In this study, we examined the association between change in LVEF and adverse outcomes.Methods: HFmrEF patients with at least two or more echocardiograms 3 months apart at the First Affiliated Hospital of Dalian Medical University between September 1, 2015 and November 30, 2019 were identified. According to the prior LVEF, the subjects were divided into improved group (prior LVEF < 40%), stable group (prior LVEF between 40 and 50%), and deteriorated group (prior LVEF ≥ 50%). The primary outcomes were cardiovascular death, all-cause mortality, hospitalization for worsening heart failure, and composite event of all-cause mortality or all-cause hospitalization.Results: A total of 1,168 HFmrEF patients (67.04% male, mean age 63.60 ± 12.18 years) were included. The percentages of improved, stable, and deteriorated group were 310 (26.54%), 334 (28.60%), and 524 (44.86%), respectively. After a period of follow-up, 208 patients (17.81%) died and 500 patients met the composite endpoint. The rates of all-cause mortality were 35 (11.29%), 55 (16.47%), and 118 (22.52%), and the composite outcome was 102 (32.90%), 145 (43.41%), and 253 (48.28%) for the improved, stable, and deteriorated groups, respectively. Cox regression analysis showed that the deterioration group had higher risk of cardiovascular death (HR: 1.707, 95% CI: 1.064–2.739, P = 0.027), all-cause death (HR 1.948, 95% CI 1.335–2.840, P = 0.001), and composite outcome (HR 1.379, 95% CI 1.096–1.736, P = 0.006) compared to the improvement group. The association still remained significant after fully adjusted for both all-cause mortality (HR = 1.899, 95% CI 1.247–2.893, P = 0.003) and composite outcome (HR: 1.324, 95% CI: 1.020–1.718, P = 0.035).Conclusion: HFmrEF patients are heterogeneous with three different subsets identified, each with different outcomes. Strategies for managing HFmrEF should include previously measured LVEF to allow stratification based on direction changes in LVEF to better optimize treatment.

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“…Guideline-recommended pharmacotherapies for HFrEF such as ACEIs/ARBs [ 14 , 15 ], β-blockers [ 16 , 17 ], and MRAs [ 18 ] have limited benefits in HFpEF, [ 19 ] and HFmrEF [ 20 ], likely reflecting the different underlying pathophysiological processes. Studies looking to further characterize the pathophysiology, patient’s demographics and clinical characteristics in the development of strategies for the management of HFpEF and HFmrEF categories are ongoing [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients

Parajuli

Shakib

Eng-Frost

et al. 2021

BMC Cardiovasc Disord

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Background Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics—with and without the direct involvement of a pharmacist. Methods A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist. Results MACS clinic patients were significantly older (80 vs. 73 years, p < .001), more likely to be female (p < .001), and had significantly higher systolic (123 vs. 112 mmHg, p < .001) and diastolic (67 vs. 60 mmHg, p < .05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed β-blockers and mineralocorticoid receptor antagonists. Use of digoxin in chronic atrial fibrillation (AF) in MACS clinic was significantly higher in HFrEF patients (82.5% vs. 58.5%, p = 0.004), but the number of people anticoagulated in presence of AF (27.1% vs. 48.0%, p = 0.002) and prescribed diuretics (84.0% vs. 94.5%, p = 0.022) were significantly lower in HFpEF patients attending the MACS clinic. Age, heart rate, systolic blood pressure (SBP), anemia, chronic renal failure, and other comorbidities were the main significant predictors of utilization of GDMT in a multivariate binary logistic regression. Conclusions Lower prescription rates of some medications in the pharmacist-involved multidisciplinary team were found. Careful consideration of demographic and clinical characteristics, contraindications for use of medications, polypharmacy, and underlying comorbidities is necessary to achieve best practice.

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Novel Mechanisms in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction

Cited by 21 publications

References 56 publications

Predictive value of H₂FPEF score in patients with heart failure with preserved ejection fraction

Predictive value of H₂FPEF score in patients with heart failure with preserved ejection fraction

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients

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Novel Mechanisms in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction

Cited by 21 publications

References 56 publications

Predictive value of H2FPEF score in patients with heart failure with preserved ejection fraction

Predictive value of H2FPEF score in patients with heart failure with preserved ejection fraction

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients

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Product

Resources

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Predictive value of H₂FPEF score in patients with heart failure with preserved ejection fraction

Predictive value of H₂FPEF score in patients with heart failure with preserved ejection fraction