Development of Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction

Farr, Grant; Shah, Keyur B.; Markley, Roshi; Abbate, Antonio; Salloum, Fadi N.; Grinnan, Dan

doi:10.1016/j.pcad.2016.06.002

Cited by 17 publications

(11 citation statements)

References 54 publications

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“…In recent years, HFpEF has received a considerable amount of attention from the medical community, but its diagnosis remains difficult. At present, the diagnosis of HFpEF depends on clinical features of HF, serum natriuretic peptide (NP) level, and evidence acquired by echocardiography of cardiac morphological changes and LVDF impairment . The difficulty to confirm HFpEF is differentiating it in patients who have symptoms and signs of heart failure but an LVEF ≥ 50%.…”

Section: Discussionmentioning

confidence: 95%

Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction

et al. 2019

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Objectives The diagnostic difficulty of heart failure with preserved ejection fraction (HFpEF) is differentiating it in patients with similar symptoms and signs. This study aimed to assess the potential predictive value of left ventricular global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), and global area strain (GAS) measured by four‐dimensional speckle tracking echocardiography (4DSTE) combined with red cell distribution width (RDW) in patients with HFpEF. Methods One hundred and sixty‐nine patients with symptoms or signs indicative of chronic heart failure and a left ventricular ejection fraction (LVEF) ≥ 50% and fifty controls with normal LVEF were recruited in this study. Standard echocardiography and 4DSTE examinations were performed. Laboratory examinations including RDW were performed on the same day as the echocardiographic study. Results GLS, GCS, GRS, and GAS in the patient cohort were significantly lower, and RDW was significantly higher than those in the control cohort (P < 0.01), and the strain parameters in definite HFpEF patients were also dramatically lower than the rest patients (P < 0.01). The associations of age, gender, NYHA classification, hypertension history, left ventricular end‐diastolic volume index, interventricular septal thickness, and diastolic dysfunction with HFpEF were significantly improved by adding 4DSTE parameters (P < 0.01) and further improved by adding RDW (P < 0.01). Conclusions In suspected HFpEF patients, who have symptoms or signs of heart failure, even without other conventional evidence of this diagnosis, GLS, GRS, and GCS have potential independent predictive value, while RDW has independent incremental predictive value for HFpEF.

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Section: Discussionmentioning

confidence: 95%

Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction

et al. 2019

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“…; Farr et al . ). In fact, the prevalence of metabolic syndrome is observed in more than 94% of patients with PH‐HFpEF (Robbins et al .…”

Section: Definitions Classification Of Subtypes and Diagnostic Factomentioning

confidence: 97%

“…PH), imposing an economic burden of about $7.7 billion per annum (Farr et al . ; Savarese & Lund, ).…”

Section: Definitions Classification Of Subtypes and Diagnostic Factomentioning

confidence: 98%

Insights into the pulmonary vascular complications of heart failure with preserved ejection fraction

Lai

Wang

Gladwin

2018

The Journal of Physiology

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Pulmonary hypertension in the setting of heart failure with preserved ejection fraction (PH-HFpEF) is a growing public health problem that is increasing in prevalence. While PH-HFpEF is defined by a high mean pulmonary artery pressure, high left ventricular end-diastolic pressure and a normal ejection fraction, some HFpEF patients develop PH in the presence of pulmonary Yen-Chun (Charly) Lai is an Assistant Professor at Indiana University. Her lab focuses primarily on investigating pathogenesis and development of alternative therapies for effective treatment of cardiopulmonary diseases, with the particular emphasis of metabolic syndrome, pulmonary hypertension and heart failure with preserved ejection fraction. Mark Gladwin is a Jack D. Myers Professor and Chair at University of Pittsburgh. He is recognized internationally as an expert in pulmonary hypertension, having described the pathobiology and clinical characteristics of pulmonary hypertension in patients with sickle cell disease and other chronic hereditary and acquired haemolytic diseases. He served on the Dana Point Pulmonary Hypertension Classification Committee and co-authored the report. He served on the NHLBI advisory committee to develop the 'Strategic Plan for Lung Vascular Research' . He has authored more than 10 textbook chapters on pulmonary vascular disease and has published over 100 papers on the topic of pulmonary hypertension alone. vascular remodelling with a high transpulmonary pressure gradient or pulmonary vascular resistance. Ageing, increased left atrial pressure and stiffness, mitral regurgitation, as well as features of metabolic syndrome, which include obesity, diabetes and hypertension, are recognized as risk factors for PH-HFpEF. Qualitative studies have documented that patients with PH-HFpEF develop more severe symptoms than those with HFpEF and are associated with more significant exercise intolerance, frequent hospitalizations, right heart failure and reduced survival. Currently, there are no effective therapies for PH-HFpEF, although a number of candidate drugs are being evaluated, including soluble guanylate cyclase stimulators, phosphodiesterase type 5 inhibitors, sodium nitrite and endothelin receptor antagonists. In this review we attempt to provide an updated overview of recent findings pertaining to the pulmonary vascular complications in HFpEF in terms of clinical definitions, epidemiology and pathophysiology. Mechanisms leading to pulmonary vascular remodelling in HFpEF, a summary of pre-clinical models of HFpEF and PH-HFpEF, and new candidate therapeutic strategies for the treatment of PH-HFpEF are summarized. Abstract figure legendPrevalence and pathophysiology of pulmonary hypertension (PH) in patients with heart failure with preserved ejection fraction (HFpEF). LA, left atrium; LV, left ventricle; LVEDP, left ventricular end-diastolic pressure; PA, pulmonary artery/arterial; PV, pulmonary vein; PVR, pulmonary vascular resistance; RV, right ventricle. Definitions, classification of subtypes and diagnostic factors of...

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“…12,16 This concern was acknowledged in the 2015 Ambrisentan and Tadalafil in Patients With Pulmonary Arterial Hypertension (AM-BITION) study after investigators changed the protocol to exclude patients who technically met the criteria for WHO group 1 PAH, but had borderline-elevated pulmonary artery occlusion pressure and additional risk factors worrisome for left heart disease and occult WHO group 2 pulmonary hypertension. 17,18 Several strategies, including passive legraising, fluid challenge, and exercise during diagnostic right heart catheterization, have been proposed to better classify these patients. 19 Unfortunately, due to a lack of standardization of normal values and methodology for executing these maneuvers, consensus is lacking over their routine use, and recommendations for their use have not been provided.…”

Section: Occult Group 2 Pulmonary Hypertensionmentioning

confidence: 99%

Evaluating suspected pulmonary hypertension: A structured approach

Bhatnagar

Wiesen²,

Dweik³

et al. 2018

CCJM

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Pulmonary arterial hypertension (PAH) is a common consideration when patients have unexplained signs of cardiopulmonary disease. Guidelines have been issued regarding diagnosis and management of this condition. Since multiple conditions can mimic components of PAH, the clinician should think about the patient's total clinical condition before diagnosing and categorizing it. Proper evaluation and etiologic definition are crucial to providing the appropriate therapy. This review offers a case-based guide to the evaluation of patients with suspected PAH.

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Development of Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction

Cited by 17 publications

References 54 publications

Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction

Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction

Insights into the pulmonary vascular complications of heart failure with preserved ejection fraction

Evaluating suspected pulmonary hypertension: A structured approach

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