Heart failure with preserved ejection fraction in the elderly: scope of the problem

Abstract

Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults, particularly women, and is increasing in prevalence as the population ages. With morbidity and mortality on par with HF with reduced ejection fraction, it remains a most challenging clinical syndrome for the practicing clinician and basic research scientist. Originally considered to be predominantly caused by diastolic dysfunction, more recent insights indicate that HFpEF in older persons is typified by a broad range of cardiac and non-cardiac abnormalities and reduced reserve capacity in multiple organ systems. The globally reduced reserve capacity is driven by: 1) inherent age-related changes; 2) multiple, concomitant co-morbidities; 3) HFpEF itself, which is likely a systemic disorder. These insights help explain why: 1) comorbidities are among the strongest predictors of outcomes; 2) approximately 50% of clinical events in HFpEF patients are non-cardiovascular; 3) clinical drug trials in HFpEF have been negative on their primary outcomes. Embracing HFpEF as a true geriatric syndrome, with complex, multi-factorial pathophysiology and clinical heterogeneity could provide new mechanistic insights and opportunities for progress in management.

Pathophysiology of heart failure and frailty: a common inflammatory origin?

“…The subsequent inflammation could lead to frailty and could also negatively effect myocardial function ‘from a distance’ via the negative inotropic effects of the circulating cytokines (Mann, 2015). Interestingly, chronic inflammation and associated vascular dysfunction have also recently been linked to HFpEF (Paulus & Tschope, 2013; Glezeva et al ., 2015; Franssen et al ., 2016), the most common form of HF in the older adults (Upadhya et al ., 2015). Systemic inflammation can also accelerate skeletal muscle apoptosis and promote sarcopenia (Muscaritoli et al ., 2010).…”

B-Type Natriuretic Peptide in Heart Failure With Preserved Ejection Fraction ― Relevance to Age-Related Left Ventricular Modeling in Japanese ―

“…38 Suppression of chronic systemic inflammation and increased systolic blood pressure together with pulse pressure are therefore expected to be effective for HFpEF particularly in those with predominant or isolated systolic hypertension. However, increased systolic pressure and pulse pressure, and chronic systemic inflammation are intrinsically related to aging 13,16,26,34, 35 and it is challenging to suppress or delay the progress of aging itself. It is interesting to note in this connection that intensive systolic blood pressure control prevented the development of major cardiovascular events, particularly HF in older patients with hypertension, as compared with standard blood pressure control, in very recent trials.…”

Determination of Cardiac Ejection Fraction by Electrical Impedance Tomography using Simulation Models and Computational Intelligence

“…The cardiac ejection fraction is considered an important clinical parameter because its high correlation with the functional state of the heart. The value of change in left ventricular ejection fraction change are associated to some heart diseases, such as aortic regurgitation [1][2][3] and identifies highrisk patients, who are likely to benefit from a more aggressive therapeutic strategy [4]. There are several non-invasive techniques that can be applied to determine the EF as echocardiogram, cardiac catheterization, cardiac magnetic resonance, computerized tomography, and others.…”