Heart failure with mildly reduced ejection fraction: from diagnosis to treatment. Gaps and dilemmas in current clinical practice

Cvijić, Marta; Rib, Yelena; Danojevic, Suzana; Radulescu, Crina Ioana; Nazghaidze, Natia; Vardas, Panos

doi:10.1007/s10741-022-10267-1

Cited by 9 publications

(6 citation statements)

References 80 publications

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“…11 While medications for treating HF with reduced nonvalvular ejection fraction can provide temporary relief of clinical symptoms in patients, their long-term treatment outcomes are not always optimal, impacting patients' prognosis and overall quality of life. [12][13][14] Following HF education intervention, the treatment outcomes for HF patients showed significant improvement, aligning with findings from previous studies. 15,16 This study found that the total effective rate of patients who received HF education intervention was higher than those who did not receive such intervention.…”

Section: Comparative Analysis Of the Incidence Of Adverse Cardiovascu...supporting

confidence: 87%

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Improving therapeutic outcomes in heart failure with reduced nonvalvular ejection fraction: A clinical study of heart failure education intervention

Tian,

Li,

Zhang

et al. 2024

Clinical Cardiology

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ObjectiveThe current study delves into the impact of heart failure education intervention on improving therapeutic outcomes for heart failure (HF) patients with reduced nonvalvular ejection fraction.MethodsThere involved a total of 60 HF patients with non‐valvular ejection fraction reduction who met the inclusion requirements. Patients enrolled were randomly distributed into an observation group and a control group. The observation group received heart failure education intervention, while the control group received conventional intervention. The therapeutic effect, changes in physical indicators, cardiac function indicators, coagulation function, self‐management scale scores, and the incidence of adverse cardiovascular events were meticulously evaluated.ResultsThe total effective proportion in the observation group was 96.67%, which was significantly higher than the control group's proportion of 76.67% (p < .05). After treatment, several parameters in the observation group showed significant improvements compared to the control group: hs‐CRP, IL‐6, LVEDV value, LVESV value, PT value, APTT value, and TT value were all evidently lower in the observation group. Additionally, the cardiac index, LVEF value, and heart failure self‐management scale fraction were significantly higher in the observation group compared to the control group (p < .05). Furthermore, the incidence of adverse cardiovascular events in the observation group was only 6.67%, which was significantly lower than the control group's incidence of 20.00% (p < .05).ConclusionHeart failure education intervention demonstrates effectiveness in improving the therapeutic outcomes for HF patients and reduced nonvalvular ejection fraction. Additionally, it enhances patients' self‐management abilities. Given these positive results, it is highly recommended to promote and implement HF education intervention in clinical practice.

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Section: Comparative Analysis Of the Incidence Of Adverse Cardiovascu...supporting

confidence: 87%

“… 11 While medications for treating HF with reduced nonvalvular ejection fraction can provide temporary relief of clinical symptoms in patients, their long‐term treatment outcomes are not always optimal, impacting patients' prognosis and overall quality of life. 12 , 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

Improving therapeutic outcomes in heart failure with reduced nonvalvular ejection fraction: A clinical study of heart failure education intervention

Tian,

Li,

Zhang

et al. 2024

Clinical Cardiology

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“…Recent ESC HF guidelines (2021) have changed the terminology of HF with mid-range LVEF to HF with mildly reduced LVEF (HFmrEF), as retrospective subgroup analysis of clinical trials and observational studies that included patients with LVEF 40–50% have shown some benefit from proven therapies for HFrEF [ 2 ]. In the era of early coronary revascularization, the number of patients with mildly reduced LVEF after acute MI is increasing, and ischemic heart disease is the leading etiology for HFmrEF, comparable to HFrEF [ 20 ]. In our cohort, similar rates of risk factors and comorbidities were seen in ACS patients with LVEF ≤40% and 41–49%, though as expected, patients with more reduced LVEF were reported to have higher rates of HF during hospitalization with a trend towards worse cardiovascular outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In our cohort, similar rates of risk factors and comorbidities were seen in ACS patients with LVEF ≤40% and 41–49%, though as expected, patients with more reduced LVEF were reported to have higher rates of HF during hospitalization with a trend towards worse cardiovascular outcomes. Whether HFmrEF is a distinct entity or a transition phase between HFrEF and HFpEF, is controversial, as HFmrEF often has a complex pathophysiology and diverse clinical phenotypes [ 20 ]. The revised treatment recommendations for HFmrEF support providing drug therapy similar to HFrEF but with a weaker class of recommendation, except for SGLT2I and diuretics in congested patients [ 2 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Heart Failure Therapies following Acute Coronary Syndromes with Reduced Ejection Fraction: Data from the ACSIS Survey

Zafrir

Ovdat

Akel

et al. 2023

JPM

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Background: Guideline-directed medical therapies for heart failure (HF) may benefit patients with reduced left ventricular ejection fraction (LVEF) following acute coronary syndromes (ACS). Few real-world data are available regarding the early implementation of HF therapies in patients with ACS and reduced LVEF. Methods: Data collected from the 2021 nationwide, prospective ACS Israeli Survey (ACSIS). Drug classes included: (a) angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNI); (b) beta-blockers; (c) mineralocorticoid receptor antagonist (MRA) and (d) sodium-glucose cotransporter-2 inhibitors (SGLT2I). The utilization of HF therapies at discharge or 90 days following ACS was analyzed in relation to LVEF [reduced ≤40% (n = 406) or mildly-reduced 41–49% (n = 255)] and short-term adverse outcomes. Results: History of HF, anterior wall myocardial infarction and Killip class II-IV (32% vs. 14% p < 0.001) were more prevalent in those with reduced compared to mildly-reduced LVEF. ACEI/ARB/ARNI and beta-blockers were used by the majority of patients in both LVEF groups, though ARNI was prescribed to only 3.9% (LVEF ≤ 40%). MRA was used by 42.9% and 12.2% of patients with LVEF ≤40% and 41–49%, respectively, and SGLT2I in about a quarter of both LVEF groups. Overall, ≥3 HF drug classes were documented in 44% of the patients. A trend towards higher rates of 90-day HF rehospitalizations, recurrent ACS or all-cause death was noted in those with reduced (7.6%) vs. mildly-reduced (3.7%) LVEF, p = 0.084. No association was observed between the number of HF drug classes or the use of ARNI and/or SGLT2I with adverse clinical outcomes. Conclusions: In current clinical practice, the majority of patients with reduced and mildly-reduced LVEF are treated by ACEI/ARB and beta-blockers early following ACS, whereas MRA is underutilized and the adoption of SGLT2I and ARNI is low. A greater number of therapeutic classes was not associated with reduced short-term rehospitalizations or mortality.

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“…Heart failure (HF) is a leading cause of death worldwide, and it is one of the fastest growing health concerns, with a global prevalence of ~ 40 million individuals [ 1 ]. However, HF is a complex clinical syndrome with different clinical phenotypes, and it is characterized by a diverse spectrum of structural abnormalities of the left ventricle (LV) [ 2 ]. Pathological cardiac hypertrophy is generally considered a critical risk factor for HF [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

GSTM2 alleviates heart failure by inhibiting DNA damage in cardiomyocytes

Xu,

Wang,

Wang

et al. 2023

Cell Biosci

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Background Heart failure (HF) seriously threatens human health worldwide. However, the pathological mechanisms underlying HF are still not fully clear. Results In this study, we performed proteomics and transcriptomics analyses on samples from human HF patients and healthy donors to obtain an overview of the detailed changes in protein and mRNA expression that occur during HF. We found substantial differences in protein expression changes between the atria and ventricles of myocardial tissues from patients with HF. Interestingly, the metabolic state of ventricular tissues was altered in HF samples, and inflammatory pathways were activated in atrial tissues. Through analysis of differentially expressed genes in HF samples, we found that several glutathione S-transferase (GST) family members, especially glutathione S-transferase M2-2 (GSTM2), were decreased in all the ventricular samples. Furthermore, GSTM2 overexpression effectively relieved the progression of cardiac hypertrophy in a transverse aortic constriction (TAC) surgery-induced HF mouse model. Moreover, we found that GSTM2 attenuated DNA damage and extrachromosomal circular DNA (eccDNA) production in cardiomyocytes, thereby ameliorating interferon-I-stimulated macrophage inflammation in heart tissues. Conclusions Our study establishes a proteomic and transcriptomic map of human HF tissues, highlights the functional importance of GSTM2 in HF progression, and provides a novel therapeutic target for HF.

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Heart failure with mildly reduced ejection fraction: from diagnosis to treatment. Gaps and dilemmas in current clinical practice

Cited by 9 publications

References 80 publications

Improving therapeutic outcomes in heart failure with reduced nonvalvular ejection fraction: A clinical study of heart failure education intervention

Improving therapeutic outcomes in heart failure with reduced nonvalvular ejection fraction: A clinical study of heart failure education intervention

Heart Failure Therapies following Acute Coronary Syndromes with Reduced Ejection Fraction: Data from the ACSIS Survey

GSTM2 alleviates heart failure by inhibiting DNA damage in cardiomyocytes

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