Sex Differences in Heart Failure With Preserved Ejection Fraction Reflected by B-type Natriuretic Peptide Level

Harada, Eisaku; Mizuno, Yuji; Kugimiya, Fumihito; Shono, Masayuki; Maeda, Hitoshi; Yano, Naotsugu; Yasue, Hirofumi

doi:10.1016/j.amjms.2018.06.009

Cited by 15 publications

(17 citation statements)

References 46 publications

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“…Interestingly, inclusion of NT-proBNP cut-off points did not incrementally add diagnostic ability to the score [54]. This again confirms that, contrary to acute symptom exacerbation, in ambulatory patients with stable, exertional dyspnea, the discriminative value of NP measurements for HFpEF is relatively low because chronic HFpEF patients may have low NP concentrations, and patients with normal LV diastolic function can have elevated NPs due to AF or other comorbidities [35][36][37][38][39][40].…”

Section: Evidence-based Assessment Of Hfpef Probability: the 2018 H 2mentioning

confidence: 71%

“…If NP measurement is available, lower cut-off points (BNP of 35 pg/mL or NT-proBNP of 125 pg/mL, consistent with the 2016 ESC guidelines on HF) are adopted in step 1 due to their higher sensitivity and negative predictive value [1,5]. Still, almost one fifth of patients with invasively proven HFpEF had NT-proBNP below this threshold, and thus normal NP concentrations do not exclude chronic HFpEF, especially in obese patients [24,[35][36][37][38][39][40]. Standard echocardiography aims to exclude alter-native cardiac causes of dyspnea, assess EF (with "preserved EF" defined as ≥ 50%), and identify features suggestive of HFpEF, such as nondilated LV with concentric remodeling or hypertrophy, and LA enlargement.…”

Section: Step 1 (P): Pretest Assessmentmentioning

confidence: 99%

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On the search for the right definition of heart failure with preserved ejection fraction

et al. 2020

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The definition of heart failure with preserved ejection fraction (HFpEF) has evolved from a clinically based "diagnosis of exclusion" to definitions focused on objective evidence of diastolic dysfunction and/ /or elevated left ventricular filling pressures. Despite advances in our understanding of HFpEF pathophysiology and the development of more sophisticated imaging modalities, the diagnosis of HFpEF remains challenging, especially in the chronic setting, given that symptoms are provoked by exertion and diagnostic evaluation is largely conducted at rest. Invasive hemodynamic study, and in particularinvasive exercise testing, is considered the reference method for HFpEF diagnosis. However, its use is limited as opposed to the high number of patients with suspected HFpEF. Thus, diagnostic criteria for HFpEF should be principally based on non-invasive measurements. As no single non-invasive variable can adequately corroborate or refute the diagnosis, different combinations of clinical, echocardiographic, and/or biochemical parameters have been introduced. Recent years have brought an abundance of HF-pEF definitions. Here, we present and compare four of them: 1) the 2016 European Society of Cardiology criteria for HFpEF; 2) the 2016 echocardiographic algorithm for diagnosing diastolic dysfunction; 3) the 2018 evidence-based H 2 FPEF score; and 4) the most recent, 2019 Heart Failure Association HFA-PEFF algorithm. These definitions vary in their approach to diagnosis, as well as sensitivity and specificity. Further studies to validate and compare the diagnostic accuracy of HFpEF definitions are warranted. Nevertheless, it seems that the best HFpEF definition would originate from a randomized clinical trial showing a favorable effect of an intervention on prognosis in HFpEF.

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Section: Evidence-based Assessment Of Hfpef Probability: the 2018 H 2mentioning

confidence: 71%

Section: Step 1 (P): Pretest Assessmentmentioning

confidence: 99%

On the search for the right definition of heart failure with preserved ejection fraction

et al. 2020

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“…apparent in patients with heart failure. 248 When compared with men, women with HFpEF have lower levels of the biologically active BNP 249 -but not the inactive prohormone, N-terminal proBNP 250 -consistent with increased adiposity-related neprilysin-mediated breakdown of the former, but not the latter. 185 Thus, systemic inflammatory and metabolic disorders are characterized by an increase in proinflammatory mediators (aldosterone and leptin) and decrease in the counterbalancing effects of natriuretic peptides.…”

Section: Sex and The Neurohormonal Response To Adipose Tissue Inflammmentioning

confidence: 97%

Characterization of the inflammatory‐metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease

Packer

Lam

Lund

et al. 2020

European J of Heart Fail

110

109

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Accumulating evidence points to the existence of an inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction (HFpEF), which is characterized by biomarkers of inflammation, an expanded epicardial adipose tissue mass, microvascular endothelial dysfunction, normal-to-mildly increased left ventricular volumes and systolic blood pressures, and possibly, altered activity of adipocyte-associated inflammatory mediators. A broad range of adipogenic metabolic and systemic inflammatory disorders-e.g. obesity, diabetes and metabolic syndrome as well as rheumatoid arthritis and psoriasis-can cause this phenotype, independent of the presence of large vessel coronary artery disease. Interestingly, when compared with men, women are both at greater risk of and may suffer greater cardiac consequences from these systemic inflammatory and metabolic disorders. Women show disproportionate increases in left ventricular filling pressures following increases in central blood volume and have greater arterial stiffness than men. Additionally, they are particularly predisposed to epicardial and intramyocardial fat expansion and imbalances in adipocyte-associated proinflammatory mediators. The hormonal interrelationships seen in inflammatory-metabolic phenotype may explain why mineralocorticoid receptor antagonists and neprilysin inhibitors may be more effective in women than in men with HFpEF. Recognition of the inflammatory-metabolic phenotype may improve an understanding of the pathogenesis of HFpEF and enhance the ability to design clinical trials of interventions in this heterogeneous syndrome.

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“…Goyal et al included 1,889,608 hospitalizations due to HFpEF, and showed that the prevalence of hospitalizations was significantly higher among women than men (64% vs. 36%) [6]. Harada et al also reported significantly higher prevalence of HFpEF in women than in men (529 women vs. 204 men, p < 0.001) [7]. Duca et al confirmed these findings in a small study that included 260 HFpEF patients (181 females and 79 males) [8].…”

Section: Epidemiologymentioning

confidence: 99%

“…Goyal et al demonstrated that obesity was significantly more prevalent among women than men with HFpEF [6]. However, Harada et al showed that obesity, defined as a BMI > 25 kg/m 2 , was more prevalent in men than in women with HFpEF [7]. However, BMI correlated with plasma brain natriuretic peptide (BNP) only in women, but not in men with HFpEF [7].…”

Section: Pathophysiologymentioning

confidence: 99%

Sex and Heart Failure with Preserved Ejection Fraction: From Pathophysiology to Clinical Studies

Tadić

Cuspidi

Plein

et al. 2019

JCM

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Heart failure with preserved ejection fraction (HFpEF) represents the most frequent form of heart failure in women, with almost two-fold higher prevalence than in men. Studies have revealed sex-specific HFpEF pathophysiology, and suggested the possibility of a sex-specific therapeutic approach in these patients. Some cardiovascular risk factors, such as arterial hypertension, obesity, diabetes mellitus, coronary artery disease, atrial fibrillation, and race, show specific features that might be responsible for the development of HFpEF in women. These risk factors are related to specific cardiovascular changes—left ventricular diastolic dysfunction and hypertrophy, ventricular–vascular coupling, and impaired functional capacity—that are related to specific cardiac phenotype and HFpEF development. However, there is no agreement regarding outcomes in women with HFpEF. For HFpEF, most studies have found higher hospitalization rates for women than for men. Mortality rates are usually not different. Pharmacological treatment in HFpEF is challenging, along with many unresolved issues and questions raised. Available data on medical therapy in patients with HFpEF show no difference in outcomes between the sexes. Further investigations are necessary to better understand the pathophysiology and mechanisms of HFpEF, as well as to improve and eventually develop sex-specific therapy for HFpEF.

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Sex Differences in Heart Failure With Preserved Ejection Fraction Reflected by B-type Natriuretic Peptide Level

Cited by 15 publications

References 46 publications

On the search for the right definition of heart failure with preserved ejection fraction

On the search for the right definition of heart failure with preserved ejection fraction

Characterization of the inflammatory‐metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease

Sex and Heart Failure with Preserved Ejection Fraction: From Pathophysiology to Clinical Studies

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