Abstract:Acute heart failure (AHF) is one of the most frequent causes of hospital admission, and presents frequently with the phenotype of preserved left ventricular (LV) ejection fraction (EF). 1 The 30-day readmission rate for AHF with preserved EF (AHF-pEF) may be as high as 23% and one-third of the AHF-pEF patients may experience fatal events during the index hospitalization. 2 Among different pathogenetic mechanisms precipitating AHF, pressure and e fluid overloads are common. [3][4][5][6] According to the classif… Show more
“…Heart failure with preserved ejection fraction is a heterogeneous syndrome with multiple aetiologies and phenotypes and accounts for more than half of the HF hospitalizations. 84,85,[203][204][205][206][207] Kammerlander et al investigated the prevalence of HFpEF following left-sided valve repair. Among 673 patients included, 67.4% fulfilled all criteria of HFpEF according to current guideline recommendations.…”
Section: Heart Failure With Preserved Ejection Fraction Epidemiology ...mentioning
confidence: 99%
“…Heart failure with preserved ejection fraction is a heterogeneous syndrome with multiple aetiologies and phenotypes and accounts for more than half of the HF hospitalizations 84,85,203–207 . Kammerlander et al .…”
Section: Heart Failure With Preserved Ejection Fractionmentioning
In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.
“…Heart failure with preserved ejection fraction is a heterogeneous syndrome with multiple aetiologies and phenotypes and accounts for more than half of the HF hospitalizations. 84,85,[203][204][205][206][207] Kammerlander et al investigated the prevalence of HFpEF following left-sided valve repair. Among 673 patients included, 67.4% fulfilled all criteria of HFpEF according to current guideline recommendations.…”
Section: Heart Failure With Preserved Ejection Fraction Epidemiology ...mentioning
confidence: 99%
“…Heart failure with preserved ejection fraction is a heterogeneous syndrome with multiple aetiologies and phenotypes and accounts for more than half of the HF hospitalizations 84,85,203–207 . Kammerlander et al .…”
Section: Heart Failure With Preserved Ejection Fractionmentioning
In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.
“…Presence of congestion, either pulmonary or systemic, is currently considered the leading cause of HF hospital admissions. [74][75][76][77] Acute HF hospitalizations are associated with subsequent increase in mortality and CV events. 78 Patients with persistent congestion and chronic kidney disease (CKD) present increased cytokine levels, which may lead to adverse outcomes.…”
Section: Acute Heart Failurementioning
confidence: 99%
“…Presence of congestion, either pulmonary or systemic, is currently considered the leading cause of HF hospital admissions 74–77 . Acute HF hospitalizations are associated with subsequent increase in mortality and CV events 78 .…”
Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.
“…They lead to elevated LV filling pressure and left atrial pressure (LAP) at rest or during exercise and may cause pulmonary hypertension (PH), with consequent exertional dyspnoea and exercise limitation or pulmonary oedema (Fig. 1 ) [ 29 – 34 ]. Fig.…”
Section: The Role Of Left Atrial Pressure and The Rationale For The D...mentioning
Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of heart failure hospital admissions in the last years and is burdened by high mortality and poor quality of life. Providing effective management for HFpEF patients is a major unmet clinical need. Increase in left atrial pressure is the key determinant of pulmonary congestion, with consequent dyspnoea and exercise limitation. Evidence on benefits of medical treatment in HFpEF patients is limited. Thus, alternative strategies, including devices able to reduce left atrial pressure, through an interatrial communication determining a left–right shunt, were developed. This review aims to summarize evidence regarding the use of percutaneous interatrial shunting devices. These devices are safe and effective in improving hemodynamic and clinical parameters, including pulmonary capillary wedge pressure, 6-min walking distance, and New York Heart Association functional class. Data on cardiovascular mortality and re-hospitalization for heart failure are still scarce.
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