Treating Heart Failure with Preserved Ejection Fraction: A Challenge for Clinicians

Howard, Patricia A.

doi:10.1310/hpj5006-454

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…In addition to lifestyle modifications, the ESC 2016 guidelines have recommended the symptomatic use of diuretics in HFpEF (3). Owing to the strong dependency between filling pressures and blood volume, obese-HFpEF patients might benefit from diuretics (15,76). By reducing blood volume, diuretics reduce right ventricular volume and ventricular interaction, which in turn improves LV end-diastolic volume (LVEDV) and stroke volume (SV), and relives pericardial restrain (15,77).…”

Section: Symptomatic Treatment With Diureticsmentioning

confidence: 99%

Epicardial Fat Expansion in Diabetic and Obese Patients With Heart Failure and Preserved Ejection Fraction—A Specific HFpEF Phenotype

Elsanhoury

Nelki

Kelle

et al. 2021

Front. Cardiovasc. Med.

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Graphical AbstractEpicardial adipose tissue (EAT)-related heart failure with preserved ejection fraction (HFpEF). Obesity and type 2 diabetes mellitus (T2DM) are common triggers of HFpEF, frequently associated with EAT expansion. EAT plays metabolic and mechanical roles in HFpEF development via para/vasocrine factors and pericardial restrain, respectively. Life-style modifications including healthy diet and regular exercise can quash the EAT expansion. Statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and fat-modulating antidiabetics including metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists can target EAT. FFA, free fatty acids; AGEs, advanced glycation end-products; NO, nitric oxide; ROS, reactive oxygen species; Ang-II, angiotensin II; TGF-β, Transforming growth factor beta; MCP-1, monocyte chemoattractant protein 1; IL-6, interleukin 6; TNF-α, tumor necrosis factor alpha. Figure created via Servier Medical Art and BioRender tools.

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Section: Symptomatic Treatment With Diureticsmentioning

confidence: 99%

Epicardial Fat Expansion in Diabetic and Obese Patients With Heart Failure and Preserved Ejection Fraction—A Specific HFpEF Phenotype

Elsanhoury

Nelki

Kelle

et al. 2021

Front. Cardiovasc. Med.

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“…However, overtreatment with diuretics resulting in undesirable side effects including dehydration, hypovolemia and sometimes hypotension and renal dysfunction, is an imminent risk. Particularly, in patients with heart failure and preserved ejection fraction (i.e., LV diastolic dysfunction), aggressive diuresis may result in cardiac output reduction, since these patients are highly sensitive to volume changes and generally have a narrow window between volume overload, causing congestive symptoms and hypovolemia leading to circulatory shock [75]. As a result, recognition of the potential hazards and individualized management is considered to be mandatory in order to protect the patient from inappropriate diuretic dosage.…”

Section: Treatment Strategies In Weaning Failure Of Cardiovascular Ormentioning

confidence: 99%

Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

Routsi¹,

Stanopoulos²,

Kokkoris³

et al. 2019

Ann. Intensive Care

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Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. In this review, we summarize the contemporary evidence of the most important clinical and diagnostic aspects of weaning failure of cardiovascular origin with special focus on treatment. Pathophysiological mechanisms are complex and mainly include increase in right and left ventricular preload and afterload and potentially induce myocardial ischemia. Patients at risk include those with preexisting cardiopulmonary disease either known or suspected. Clinically, cardiovascular etiology as a predominant cause or a contributor to weaning failure, though critical for early diagnosis and intervention, may be difficult to be recognized and distinguished from noncardiac causes suggesting the need of high suspicion. A cardiovascular diagnostic workup including bedside echocardiography, lung ultrasound, electrocardiogram and biomarkers of cardiovascular dysfunction or other adjunct techniques and, in selected cases, right heart catheterization and/or coronary angiography, should be obtained to confirm the diagnosis. Official clinical practice guidelines that address treatment of a confirmed weaning-induced cardiovascular dysfunction do not exist. As the etiologies of weaning-induced cardiovascular dysfunction are diverse, principles of management depend on the individual pathophysiological mechanisms, including preload optimization by fluid removal, guided by B-type natriuretic peptide measurement, nitrates administration in excessive afterload and/or myocardial ischemia, contractility improvement in severe systolic dysfunction as well as other rational treatment in specific indications in order to lead to successful weaning from mechanical ventilation.

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“…The ventricle’s ability to relax and fill during diastole is affected by multiple factors, including plasma volume, structural characteristics of the LV wall, active energy-driven processes involved in LV relaxation, atrial contraction, and the integrity of the mitral valve [ 21 ]. Nonetheless, HFpEF is relatively common and presents significant challenges in diagnosis and treatment [ 22 ]. Our study extends previous knowledge by demonstrating potential predictors of symptoms in HFpEF patients with its pathophysiological aspects.…”

Section: Discussionmentioning

confidence: 99%

Worsening effect of testosterone deficiency on males with heart failure with preserved ejection fraction

et al. 2022

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Background Heart failure with preserved ejection fraction (HFpEF)is challenging. Patients usually have normal LV size and ejection fraction. This clinical syndrome develops from a complex interaction of several risk factors that cause organ dysfunction and clinical symptoms. There’s evidence that testosterone deficiency is associated with a worse cardiometabolic profile and increased inflammatory markers. We thought that these changes might have an impact on heart failure pathogenesis. We aimed to study the relationship between testosterone level and symptoms in HFpEF. Methods We studied 120 male patients with HFpEF. According to New York Heart Association (NYHA), patients were classified into I, II and III classes; class IV patients were excluded. All patients were subjected to clinical and echocardiographic examinations. In addition, we measured serum testosterone, cardio-metabolic profile, intracellular adhesive molecule-1(ICAM-1), P-selectin and nitric oxide (NO) levels. Results Patients with testosterone deficiency had worse NYHA class and higher BNP P = (0.001). Additionally, they had a significantly worse metabolic profile; higher total cholesterol, triglycerides, LDL cholesterol, fasting insulin and HOMA-IR P = (0.005, 0.001, 0.001, 0.001), respectively. Also, they had higher inflammatory markers and worse endothelial functional parameters; (ICAM-1, NO and P- selectin) P = (0.001). Age, BNP and testosterone deficiency can be used as independent predictors of NYHA class III symptoms with a Testosterone cutoff value of 2.7 ng/ml. Conclusion Testosterone deficiency could be used as an independent predictor of symptom severity in HFpEF, and it aggravates systemic inflammation and endothelial dysfunction in these patients.

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Treating Heart Failure with Preserved Ejection Fraction: A Challenge for Clinicians

Cited by 8 publications

References 31 publications

Epicardial Fat Expansion in Diabetic and Obese Patients With Heart Failure and Preserved Ejection Fraction—A Specific HFpEF Phenotype

Epicardial Fat Expansion in Diabetic and Obese Patients With Heart Failure and Preserved Ejection Fraction—A Specific HFpEF Phenotype

Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature

Worsening effect of testosterone deficiency on males with heart failure with preserved ejection fraction

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