Novel percutaneous interventional therapies in heart failure with preserved ejection fraction: an integrative review

Burlacu, Alexandru; Simion, Paul; Nistor, Ionuţ; Covic, Adrian; Tinică, Grigore

doi:10.1007/s10741-019-09787-0

Cited by 13 publications

(12 citation statements)

References 44 publications

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“…SGLT2 inhibitors brought a lower risk of hospitalization for HF, but there was no improvement in death rates. Therefore, new device-based therapies that address LA decompression have been getting more attention in the area of HFpEF treatment ( 19 , 20 ).…”

Section: Depressurization Of the Left Atriummentioning

confidence: 99%

Novel approaches for left atrial pressure relief: Device-based monitoring and management in heart failure

Miyagi

Kuroda

Karimov

et al. 2022

Front. Cardiovasc. Med.

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The importance of the left atrium (LA) has been emphasized in recent years as the features of heart failure (HF), especially with regard to variability in patient and pathology phenotypes, continue to be uncovered. Of note, among the population with HF with preserved ejection fraction (HFpEF), pressure or size of the LA have become a target for advanced monitoring and a therapeutic approach. In the case of diastolic dysfunction or pulmonary hypertension, which are often observed in patients with HFpEF, a conventional approach with clinical symptoms and physical signs of decompensation turned out to have a poor correlation with LA pressure. Therefore, to optimize HF treatment for these populations, several devices that are applied directly to the LA have been developed. First, two LA pressure (LAP) sensors (Heart POD and V-LAP Device) were developed and may enable patient self-management remotely with LAP-guided and physician-directed style. Second, there are device-based approaches that aim to decompress the LA directly. These include: (1) interatrial shunt devices; (2) left ventricular assist devices with LA cannulation; and (3) the left atrial assist device. While these novel device-based therapies are not yet commercially available, there is expected to be a rise in the proposition and adoption of a wider range of choices for monitoring or treating LA using device-based options, based on LA dimensional reduction and optimization of the clinically significant pressure relief. Further development and evaluation are necessary to establish a more favorable management strategy for HF.

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Section: Depressurization Of the Left Atriummentioning

confidence: 99%

Novel approaches for left atrial pressure relief: Device-based monitoring and management in heart failure

Miyagi

Kuroda

Karimov

et al. 2022

Front. Cardiovasc. Med.

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“…The lack of effective medical therapies has sparked an interest in developing device-based therapies for HFpEF. These devices can be classified into: devices that decompress the left atrium – such as inter-atrial shunt device (IASD) and left atrial assist device (LAAD), devices that improve the left ventricle compliance such as left ventricle expander, devices that synchronize atrial contractions such as left atrial permanent pacing, and neuromodulators that activate baroreceptors in the wall of the carotid artery to restore autonomic balance (Table 1) [31,32 ▪ ].…”

Section: Novel Device-based Therapy For Managing Hypertension In Hear...mentioning

confidence: 99%

“…They store elastic energy during cardiac contraction and transfer it to the LV wall during the diastolic ring diastole to enhance diastolic recoil. Both devices are in early phases of development with ongoing trials in safety, feasibility, and efficacy [31,32 ▪ ]. Therefore, their role in HFpEF hypertensive patients remains unknown.…”

Section: Novel Device-based Therapy For Managing Hypertension In Hear...mentioning

confidence: 99%

New concepts in heart failure with preserved ejection fraction and hypertension

Joury

Gupta

Krim

2022

Current Opinion in Cardiology

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Purpose of reviewHypertension (HTN) remains the most common and strongest contributing factor to the development of heart failure with preserved ejection fraction (HFpEF). In this review, we aim to summarize the pathophysiological processes linking HTN to HFpEF and highlight novel concepts in medical and device-based management of HFpEF and HTN.Recent findingsDespite the global increase in the prevalence of HFpEF, there has been limited benefit in current medication and device-based therapy for this complex syndrome. The hallmark of HFpEF is an elevated left intra-atrial and ventricular pressure and exertional dyspnea. Traditional medications used for treating HTN in patients with reduced left ventricular ejection fraction have unclear benefits in patients with HFpEF. Careful analysis of emerging medications such as angiotensin receptor–neprilysin inhibitor and sodium–glucose co-transporter-2 inhibitors showed benefit in reducing not only blood pressure but also hospitalizations in patients with HFpEF. Current data on device-based therapy aims to reduce left intra-atrial pressure, ventricular pressure and stimulate baroreceptors to lower blood pressure; however, needs further investigation.SummaryThe nexus of HTN and HFpEF remains strong and complex. Although traditional medications for treating HFrEF did not affect long-term outcomes, novel therapies with angiotensin receptor neprilysin-inhibitor and sodium-glucose co-transporter-2 inhibitor offer promising results. Many device-based interventions in the HFpEF population are being developed with the aim to reduce left intra-atrial and ventricular pressure; however, their role in HFpEF hypertensive patients needs to be further investigated.

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“…In HFrEF, a variety of devices, including cardiac resynchronization therapy (CRT) devices and MCS devices, have completely revolutionized clinical management of these patients, dramatically improving morbidity and survival. Although no device has yet received approval by the U.S. Food and Drug Administration for HFpEF, several are currently under investigation and have shown promising results in a variety of preclinical and clinical studies ( 85 ).…”

Section: Device-based Solutions For Hfpefmentioning

confidence: 99%

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Rosalia

Ozturk

Shoar

et al. 2021

JACC: Basic to Translational Science

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Highlights The prevalence of heart failure with preserved ejection fraction among patients who present with symptoms of heart failure is approximately 50%. Pharmacologic therapy has not conclusively shown benefits in morbidity and mortality in clinical trials. Although it represents an active area of research, no device-based therapy has received regulatory approval for the treatment of heart failure with preserved ejection fraction. Approaches such as atrial shunts, left ventricular expanders, mechanical circulatory support devices, and neurostimulators are at various stages of development.

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Novel percutaneous interventional therapies in heart failure with preserved ejection fraction: an integrative review

Cited by 13 publications

References 44 publications

Novel approaches for left atrial pressure relief: Device-based monitoring and management in heart failure

Novel approaches for left atrial pressure relief: Device-based monitoring and management in heart failure

New concepts in heart failure with preserved ejection fraction and hypertension

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

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