A Novel Paradigm for Heart Failure With Preserved Ejection Fraction

Paulus, Walter J.; Tschöpe, Carsten

doi:10.1016/j.jacc.2013.02.092

Cited by 2,752 publications

(1,461 citation statements)

References 98 publications

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“…A novel paradigm in HFpEF associates comorbid conditions to an inflammatory state that increases LV stiffness and promotes HF 71. The cellular and molecular mechanisms that lead from systemic inflammation to myocardial fibrosis (reduced nitric oxide bioactivity, cyclic guanosine monophosphate content, and protein kinase G) also promote arterial stiffening, with the endothelium being an essential component of vascular homeostasis 72, 73, 74, 75.…”

Section: Aging Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

109

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Section: Aging Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

109

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“…Since fibrosis and inflammation are believed to be part of the pathogenesis of HF with preserved ejection fraction (HFpEF),5 MRA is an appealing treatment also for this patient group. The TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) study of spironolactone in HFpEF did not show any positive effects on mortality, although a post hoc regional analysis indicated beneficial effects in the American patients 6, 7.…”

Section: Introductionmentioning

confidence: 99%

Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure

Löfman

Szummer

Olsson

et al. 2018

JAHA

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BackgroundThere are no studies of mineralocorticoid receptor antagonist (MRA) treatment examining outcome in unselected real‐life patients with myocardial infarction (MI) and heart failure (HF). There is uncertainty regarding effects of MRA in relation to left ventricular ejection fraction (LVEF) and chronic kidney disease (CKD). The aim was to assess MRA use and compare outcomes in MI patients with HF in relation to LVEF and CKD.Methods and ResultsPatients with MI and HF registered in the Swedish myocardial infarction registry, SWEDEHEART, 2005–2014, were included. Associations between MRA use and all‐cause mortality up to 3 years were assessed with multivariable Cox regression, stratified by EF groups and presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2). Of 45 071 patients with MI and HF, 4470 (9.9%) received MRA. Those with HF and LVEF <40% more often had MRA (19.6%) compared with those with LVEF 40% to 49% (9.1%) or LVEF ≥50% (4.7%). 8.6% of patients with CKD received MRA. After adjustment, MRA use was associated with lower mortality in those with LVEF <40% (hazard ratio [95% confidence interval] 0.81 [0.75–0.88]) and LVEF 40% to 49% (0.88 [0.75–1.03]) but not in those with LVEF ≥50% (1.29 [1.09–1.53]), with significant interaction between MRA and LVEF (P<0.0001). The association between MRA use and mortality was similar in those without (0.96 [0.88–1.05]) and with (0.92 [0.85–0.99]) CKD.ConclusionsIn patients with MI and HF, MRA use was associated with better long‐term survival in patients with LVEF <40% but not in those with LVEF ≥50%, while the mortality risk was similar in MRA‐treated patients with or without CKD.

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“…The clinical implications of our current findings can be gauged against the prognosis associated with asymptomatic diastolic LV dysfunction, which in the general population has a prevalence of around 25%4, 5 and over time evolves to symptomatic LV dysfunction6 and heart failure2 and predicts the incidence of adverse health outcomes. Guideline‐driven echocardiographic criteria24, 25 to stage patients with advanced diastolic LV dysfunction leave a large proportion of people unclassified in population studies.…”

Section: Discussionmentioning

confidence: 89%

“…Diastolic HF, also referred to as HF with preserved ejection fraction, accounts for 50% of cases 2. Mortality of diastolic HF is 30% within 1 year of the first hospital admission 3.…”

mentioning

confidence: 99%

“…Mortality of diastolic HF is 30% within 1 year of the first hospital admission 3. Subclinical diastolic left ventricular (LV) dysfunction has a prevalence of 25% in the general population,4, 5 predisposes to further deterioration of LV function,6 and finally evolves to overt HF 2. Raised blood pressure is the major risk factor associated cross‐sectionally4, 5, 7 and prospectively6, 8, 9, 10 with diastolic LV dysfunction in the general population.…”

mentioning

confidence: 99%

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Conventional and Ambulatory Blood Pressure as Predictors of Diastolic Left Ventricular Function in a Flemish Population

Wei

Yang

Thijs

et al. 2018

JAHA

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BackgroundNo longitudinal study compared associations of echocardiographic indexes of diastolic left ventricular function studies with conventional (CBP) and daytime ambulatory (ABP) blood pressure in the general population.Methods and ResultsIn 780 Flemish (mean age, 50.2 years; 51.7% women), we measured left atrial volume index (LAVI), peak velocities of the transmitral blood flow (E) and mitral annular movement (e′) in early diastole and E/e′ 9.6 years (median) after CBP and ABP. In adjusted models including CBP and ABP, we expressed associations per 10/5‐mm Hg systolic/diastolic blood pressure increments. LAVI and E/e′ were 0.65/0.40 mL/m2 and 0.17/0.09 greater with higher systolic/diastolic ABP (P≤0.028), but not with higher baseline CBP (P≥0.086). e′ was lower (P≤0.032) with higher diastolic CBP (−0.09 cm/s) and ABP (−0.19 cm/s). When we substituted baseline CBP by CBP recorded concurrently with echocardiography, LAVI and E/e′ remained 0.45/0.38 mL/m2 and 0.15/0.08 greater with baseline ABP (P≤0.036), while LAVI (+0.53 mL/m2) and E/e′ (+0.19) were also greater (P<0.001) in relation to concurrent systolic CBP. In categorized analyses of baseline data, sustained hypertension or masked hypertension compared with normotension or white‐coat hypertension was associated with greater LAVI (24.0 versus 22.6 mL/m2) and E/e′ (7.35 versus 6.91) and lower e′ (10.7 versus 11.6 cm/s; P≤0.006 for all) with no differences (P≥0.092) between normotension and white‐coat hypertension or between masked hypertension and sustained hypertension.Conclusions ABP is a long‐term predictor of diastolic left ventricular function, statistically outperforming distant but not concurrent CBP. Masked hypertension and sustained hypertension carry equal risk for deterioration of diastolic left ventricular function.

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A Novel Paradigm for Heart Failure With Preserved Ejection Fraction

Cited by 2,752 publications

References 98 publications

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure

Conventional and Ambulatory Blood Pressure as Predictors of Diastolic Left Ventricular Function in a Flemish Population

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