Insuficiência cardíaca com fração de ejeção normal

Abstract

Heart failure with normal ejection fraction (HFNEF) is a complex syndrome that has been broadly studied since the last decade. It is caused by diastolic ventricular dysfunction demonstrated by complementary methods, such as hemodynamic study or echocardiogram, in the presence of a normal ejection fraction (EF). It affects primarily elderly individuals with comorbidities, such as systemic arterial hypertension, coronary failure and obesity. The physiopathological mechanisms are complex and multifactorial, involving the myocardial passive stiffness, the ventricular geometry, the pericardial restraint and the interaction between the ventricles. The main objectives of the treatment were to decrease the pulmonary venous congestion and the heart rate and control the comorbidities. There is no strong evidence that the use of specific medications, such as the angiotensin-converting enzyme inhibitors or beta-blockers can influence mortality. The poorer prognostic factors include advanced age, presence of kidney dysfunction, diabetes, functional class III and IV (NYHA) and advanced-stage diastolic dysfunction, with a restrictive pattern of ventricular filling. Another aspect that has been increasingly cited in the literature is the analysis of the role of the systolic function in HFNEF cases. All these aspects are analyzed in detail in the present review.

Biocompatibility of Ricinus comunnis polymer compared to titanium implant used in artificial hearts. Experimental study in guinea pigs

“…Considering the aging population worldwide, despite the epidemiological and medical practices, it is expected that this prevalence can be maintained or even increase in the coming decades [1].…”

Heart Failure with Preserved Ejection Fraction – Concept, Pathophysiology, Diagnosis and Challenges for Treatment

“…Historically viewed, a systolic dysfunction with EF < 45% was considered for heart failure. In line with Roelandt, the first association between myocardial relaxation and ventricular function was described in 1923 by Yendel Handerson, who presented data that myocardial relaxation was equally important as well as the contraction [ 4 ]. Gaasch defined the term “systolic dysfunction” in 1994 as “the inability of the heart to adapted to the blood volume during diastole and the ventricular filing was delayed and incomplete, the atrial pressure was growing, causing pulmonary or systemic congestion”.…”

“…The flow through mitral valve in diastole depends on transvalvular pressure gradient [ 4 ]. In normal conditions, this gradient is maximal immediately after the mitral valve opening, when corresponds with E-wave.…”

“…If the left atrial pressure is elevated for longer time, it causes symptoms of intolerance for physical effort (second grade of diastolic dysfunction). In patients in whom the LV diastolic pressure is so elevated, in order to restrict the transvalvular flow during the atrial contraction and constantly elevated left atrial pressure, it is called the third or restrictive type of diastolic dysfunction which is manifested with harder intolerance for physical effort [ 4 , 6 ].…”

Systems Biology Applied to Heart Failure With Normal Ejection Fraction

“…Mesquita et al and Matsubara have provided a more detailed discussion of the pathophysiology of HFNEF in two recent reviews published in the Arquivos Brasileiros de Cardiologia 3,4 .…”