Heart Failure With a Normal Left Ventricular Ejection Fraction: Epidemiology Pathophysiology, Diagnosis and Management

Garg, Nadish; Senthilkumar, A.; Nusair, Maen; Goyal, Neha; Garg, Rajeev; Alpert, Martin A.

doi:10.1097/maj.0b013e31828c586e

Cited by 25 publications

(25 citation statements)

References 97 publications

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“…433–435 Clinically, patients with diabetic cardiomyopathy and diastolic dysfunction initially present with a restrictive phenotype as heart failure with preserved ejection fraction (HFpEF). 436–438 …”

Section: Diabetic Cardiomyopathy- Clinical Phenotypementioning

confidence: 99%

Clinical Update: Cardiovascular Disease in Diabetes Mellitus

et al. 2016

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Cardiovascular disease remains the principal cause of death and disability among patients with diabetes mellitus. Diabetes exacerbates mechanisms underlying atherosclerosis and heart failure. Unfortunately, these mechanisms are not adequately modulated by therapeutic strategies focusing solely on optimal glycemic control with currently available drugs or approaches. In the setting of multi-factorial risk reduction with statins and other lipid lowering agents, anti-hypertensive therapies, and anti-hyperglycemic treatment strategies, cardiovascular complication rates are falling, yet remain higher for patients with diabetes than for those without. This review considers the mechanisms, history, controversies, new pharmacologic agents, and recent evidence for current guidelines for cardiovascular management in the patient with diabetes mellitus to support evidence-based care in the patient with diabetes and heart disease outside of the acute care setting.

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Section: Diabetic Cardiomyopathy- Clinical Phenotypementioning

confidence: 99%

Clinical Update: Cardiovascular Disease in Diabetes Mellitus

et al. 2016

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“…Although the prevalence of heart failure with preserved ejection fraction (HFpEF) is increasing and now accounts for 50 % of all cases of heart failure, there are still many unresolved issues regarding treatment [2, 16]. The primary pathophysiological mechanisms underlying HFPEF are fibrosis and reduced ventricular compliance [2].…”

Section: Discussionmentioning

confidence: 99%

“…It is well established that hypertension is a major contributor to the development of heart failure, particular diastolic heart failure. Treatment is one of the keys to preventing the development of diastolic heart failure [2]. In the United States, African Americans have the highest prevalence of heart failure present with heart failure at younger ages, and are less likely to have coronary artery disease as the primary etiology [3].…”

Section: Introductionmentioning

confidence: 99%

Antihypertensive Medications and Diastolic Dysfunction Progression in an African American Population

Prendergast

Dudley

Brown

et al. 2014

High Blood Press Cardiovasc Prev

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Background There have been no studies examining the association between antihypertensive medications and progression of diastolic dysfunction. The purpose of this study is to determine whether there is an association between class of antihypertensive medication and diastolic dysfunction progression in an African American population. Methods A retrospective cohort study of African American patients with at least two echocardiograms demonstrating diastolic dysfunction drawn from an echocardiogram database at an academic medical center. The main outcome measures were change in diastolic function grade as a function of time and association with hypertension medication classification. Results There were 96 African American patients in the database with 2 or more echocardiograms demonstrating diastolic dysfunction; representing 302 echocardiograms. The mean time between echocardiograms was 2.6 years. The mean age was 64.2 (±10.1) years, 78 % were women, and mean BMI 31.2 (±7.4) kg/m2. The majority of subjects had Grade I diastolic dysfunction at their initial examination [N = 87 (90.6 %)]. Approximately 22.9 % (n = 22) of the study cohort demonstrated diastolic dysfunction progression. In multivariate analysis use of calcium channel blockers (CCB) was protective against diastolic dysfunction progression (OR for CCB users vs. non-users 0.28, 95 % confidence interval, 0.09–0.90, p < 0.05). Conclusions These findings suggest that use of calcium channel blockers may have a protective effect against progression of diastolic dysfunction among African American patients. Further studies are required to confirm these findings and identify specific factors that can mediate disease progression among African American individuals with hypertension, who face substantial risk of complications such as diastolic heart failure.

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“…138 Although outcomes are similar in patients with HF-PEF and HF-REF, 139 no drug therapies have been shown to improve survival in HF-PEF to date. 140,141 While 2D-echocardiography has superior temporal resolution for assessment of LV filling, CMR may contribute superior assessment of LVEF, LV mass and LA volumes, in addition to correlates of pulmonary hypertension (e.g. pulmonary artery:aorta ratio 142 and RV function 143 ).…”

Section: Heart Failure With Preserved Ejection Fractionmentioning

confidence: 99%

The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure

Peterzan¹,

Rider²,

Anderson³

2016

Cardiac Failure Review

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Cardiovascular imaging is key for the assessment of patients with heart failure. Today, cardiovascular magnetic resonance imaging plays an established role in the assessment of patients with suspected and confirmed heart failure syndromes, in particular identifying aetiology. Its role in informing prognosis and guiding decisions around therapy are evolving. Key strengths include its accuracy; reproducibility; unrestricted field of view; lack of radiation; multiple abilities to characterise myocardial tissue, thrombus and scar; as well as unparalleled assessment of left and right ventricular volumes. T2* has an established role in the assessment and follow-up of iron overload cardiomyopathy and a role for T1 in specific therapies for cardiac amyloid and Anderson-Fabry disease is emerging.

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Heart Failure With a Normal Left Ventricular Ejection Fraction: Epidemiology Pathophysiology, Diagnosis and Management

Cited by 25 publications

References 97 publications

Clinical Update: Cardiovascular Disease in Diabetes Mellitus

Clinical Update: Cardiovascular Disease in Diabetes Mellitus

Antihypertensive Medications and Diastolic Dysfunction Progression in an African American Population

The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure

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