Heart Failure with Preserved Ejection Fraction—a Concise Review

Adamczak, Daria M.; Oduah, Mary-Tiffany; Kiebalo, Thomas; Nartowicz, Sonia; Bęben, Marcin; Pochylski, Mateusz; Ciepłucha, Aleksandra; Gwizdała, Adrian; Lesiak, Maciej; Straburzyńska‐Migaj, Ewa

doi:10.1007/s11886-020-01349-3

Cited by 43 publications

(32 citation statements)

References 125 publications

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“…The latest data show that the prevalence of HFmrEF in hospitalized patients ranged from 13 to 26% (9)(10)(11), while the prevalence in outpatients varied from 9 to 21% (12)(13)(14)(15)(16)(17). Nevertheless, previous studies mostly focused on HFrEF and HFpEF, with less attention paid to HFmrEF until now (18,19). Consequently, less is known regarding the clinical characteristics of patients with HFmrEF, and with limited evidence on which to base recommendation for therapy (20).…”

Section: Introductionmentioning

confidence: 99%

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Zhang

Sun

Chen

et al. 2021

Front. Cardiovasc. Med.

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Aims: Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure with preserved ejection fraction (HFpEF) deteriorates or heart failure with reduced ejection fraction (HFrEF) improves. In this study, we examined the association between change in LVEF and adverse outcomes.Methods: HFmrEF patients with at least two or more echocardiograms 3 months apart at the First Affiliated Hospital of Dalian Medical University between September 1, 2015 and November 30, 2019 were identified. According to the prior LVEF, the subjects were divided into improved group (prior LVEF < 40%), stable group (prior LVEF between 40 and 50%), and deteriorated group (prior LVEF ≥ 50%). The primary outcomes were cardiovascular death, all-cause mortality, hospitalization for worsening heart failure, and composite event of all-cause mortality or all-cause hospitalization.Results: A total of 1,168 HFmrEF patients (67.04% male, mean age 63.60 ± 12.18 years) were included. The percentages of improved, stable, and deteriorated group were 310 (26.54%), 334 (28.60%), and 524 (44.86%), respectively. After a period of follow-up, 208 patients (17.81%) died and 500 patients met the composite endpoint. The rates of all-cause mortality were 35 (11.29%), 55 (16.47%), and 118 (22.52%), and the composite outcome was 102 (32.90%), 145 (43.41%), and 253 (48.28%) for the improved, stable, and deteriorated groups, respectively. Cox regression analysis showed that the deterioration group had higher risk of cardiovascular death (HR: 1.707, 95% CI: 1.064–2.739, P = 0.027), all-cause death (HR 1.948, 95% CI 1.335–2.840, P = 0.001), and composite outcome (HR 1.379, 95% CI 1.096–1.736, P = 0.006) compared to the improvement group. The association still remained significant after fully adjusted for both all-cause mortality (HR = 1.899, 95% CI 1.247–2.893, P = 0.003) and composite outcome (HR: 1.324, 95% CI: 1.020–1.718, P = 0.035).Conclusion: HFmrEF patients are heterogeneous with three different subsets identified, each with different outcomes. Strategies for managing HFmrEF should include previously measured LVEF to allow stratification based on direction changes in LVEF to better optimize treatment.

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Section: Introductionmentioning

confidence: 99%

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Zhang

Sun

Chen

et al. 2021

Front. Cardiovasc. Med.

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“…The current definition of heart failure classifies diastolic dysfunction as a clinically symptomatic stage, when in fact, the patient may present with asymptomatic structural or functional cardiac abnormalities (systolic or diastolic left ventricular dysfunction) before the onset of clinical symptoms, an early event of heart failure. [ 1 ] It is important to identify these early events because they are associated with poor prognosis, and early intervention can significantly reduce patient fatality. [ 2 ] Elevated left ventricular end-diastolic pressure (LVEDP) is the main index of left ventricular diastolic dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic evaluation of left ventricular end diastolic pressure in patients with diastolic heart failure

et al. 2020

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To evaluate the left ventricular end diastolic pressure (LVEDP) in patients with diastolic heart failure by echocardiography and explore the clinical value of echocardiography. From July 2017 to January 2018, 120 patients were prospectively selected from the affiliated hospital of Jiangsu university diagnosed as diastolic heart failure (York Heart Association class ≥II, LVEF ≥50%). The patients were divided into group with LVEDP ≤15 mm hg (1 mm hg = 0.133 kpa) (43 cases) and the group with LVEDP >15 mm hg (77 cases) according to the real-time measurement of LVEDP. Receiver operator characteristic curves of each parameter of echocardiography in diagnosis of LVEDP were compared between the 2 groups. Common ultrasonic parameters such as left ventricular inflow tract blood flow propagation velocity, mitral valve diastole e peak velocity/mitral valve diastole a peak velocity, e peak deceleration time, a peak duration, and early diastole interventricular septum bicuspid annulus velocity e’ (e'sep) were used to evaluate LVEDP elevation with low accuracy (AUC is only between 0.5 and 0.7). Other ultrasonic parameters such as left atrial volume index (LAVI), tricuspid regurgitation maximum flow rate (TRmax), early diastole left ventricular sidewall bicuspid annulus velocity e’ (e’lat), average e’, E/e'sep, E/e’lat, average E/e’ were used to evaluate LVEDP elevation with a certain improvement in accuracy (AUC between 0.7 and 0.9). Propagation velocity, mitral valve diastole e peak velocity/mitral valve diastole a peak velocity, e peak deceleration time, a peak duration, e'sep, average e’, E/e'sep have very low correlation with LVEDP ( r = −0.283 to 0.281); LAVI, TRmax, e’lat, E/e’lat, average E/e’ and LVEDP are not highly correlated ( r = 0.330–0.478). Through real-time left ventricular manometry, multiple regression analysis showed that TRmax, average e’, e’lat, LAVI were independently correlated with the actual measured LVEDP. Echocardiography can recognize the increase of LVEDP in patients with heart failure preserved by LVEF, and estimate the value of LVEDP roughly, which can reflect LVEDP to a certain extent, with high feasibility and accuracy.

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“…Cardiovascular outcomes such as cardiovascular death, heart failure hospitalization and aborted cardiac arrest were worse in phenogroup 3 as compared to 1. All cause mortality was worse in phenogroups 2 and 3 as compared to phenogroup 1 (Adamczak et al, 2020;Cohen et al, 2020;Samson et al, 2016;Shah et al, 2017Shah et al, , 2015 The H2FPEF score appears to have good discriminatory power to distinguish HfpEf from other causes of dyspnea with a c statistic of 0.886 (Paulus, 2018;Reddy et al, 2018). The other score HFA-PEFF put forth uses functional, morphological and biomarker characteristics of HFpEF to aid diagnosis.…”

Section: Risk Factors and Outcomesmentioning

confidence: 99%

Epidemiology and pathogenesis of heart failure with preserved ejection fraction

Nair

2020

Rev. Cardiovasc. Med.

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Heart failure (HF) is a complex syndrome that affects approximately6.5 millionadults in the United States. About half of the 6.5 million adults with HF are estimated to be individuals with heart failure with preserved ejection fraction (HFpEF). It is a common cause for poor quality of life, increased health-care resource utilization, and early mortality. HF incidence has risen to epidemic proportions in the recent years. This review attempts to address the epidemiology and pathophysiology of HFpEF. The incidence of HFpEF increased from 48% to 57% from 2000 to 2007 with a slight decrease in 2010 to 52%. The temporal trends in heart failure show an overall stable incidence of HF over the last two decades with increasing incidence of HFpEF and decreasing HFrEF incidence. Many etiologies contribute to the development of HFpEF which makes the treatment very challenging. Pathophysiology of HFpEF is multifaceted stemming from several disease-specific aspects of inflammation and endothelial function, cardiomyocyte hypertrophy and fibrosis, ventricular-vascular uncoupling, pulmonary hypertension and chronotropic incompetence. Hence identifying the risk factors and etiologies is imperative to achieve optimal outcomes in this population. Newer insights into myocardial remodeling have led to an interesting finding of abnormal fibroblasts in HFpEF which are apoptosis resistant and initiate the development of an abnormal myocardial matrix resulting in initiation and progression of the disease. Upregulation of ROS has also been implicated in HFpEF. Further investigation could provide new avenues to target therapeutics specifically to stop initiation and progression of fibrosis.

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Heart Failure with Preserved Ejection Fraction—a Concise Review

Cited by 43 publications

References 125 publications

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Echocardiographic evaluation of left ventricular end diastolic pressure in patients with diastolic heart failure

Epidemiology and pathogenesis of heart failure with preserved ejection fraction

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