Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction

Massie, Barry M.; Carson, Peter E.; McMurray, John J.V.; Komajda, Michel; McKelvie, Robert S.; Zile, Michael R.; Anderson, Susan; Donovan, Mark; Iverson, Erik; Staiger, C; Ptaszynska, Agata

doi:10.1056/nejmoa0805450

Cited by 1,725 publications

(1,211 citation statements)

References 35 publications

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“…Lowering neurohormonal activation has unexpectedly failed to improve clinical outcome in large, placebo‐controlled, randomized HFpEF trials 20, 21, 22, 23, 24. Diagnostic uncertainties may partially account for the lack of therapeutic benefit 29, 76, 77.…”

Section: Aging Phenotypementioning

confidence: 99%

“…The large, all‐inclusive, randomized, placebo‐controlled therapeutic trials approach that led to great therapeutic progress in HFrEF has not worked so far in HFpEF 20, 21, 22, 23, 24, 25, 26, 27. Such discrepancy is, in part, attributable to overt differences in the pathogenesis and progression of HFpEF and HFrEF.…”

Section: Future Directionsmentioning

confidence: 99%

“…However, little therapeutic progress was made 20, 21, 22, 23, 24, 25, 26, 27. Among the issues that may account for the modest therapeutic progress, one appears to be overwhelming: HFpEF is not a well‐defined clinical entity: It is an amalgam of cardiovascular, metabolic, renal, and geriatric conditions 28, 29.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

109

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Section: Aging Phenotypementioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

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Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

109

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“…Although substantial progress has been made in the management and outcomes of heart failure with reduced ejection fraction (HFREF), outcomes associated with HFPEF remain unchanged 1, 2. Well‐established pharmacological therapies for HFREF have failed to improve prognosis in HFPEF 3, 4, 5, 6. This has largely been attributed to the phenotypic variability and the complex pathophysiological mechanisms underlying the development of HFPEF 7…”

mentioning

confidence: 99%

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

Pandey

Garg

Matulevicius

et al. 2015

JAHA

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BackgroundThere has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta‐analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF.Methods & ResultsRandomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e’, a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy‐terminal peptide of procollagen type I [PICP] and amino‐terminal peptide of pro‐collagen type‐II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e’ (weighted mean difference [WMD] [95% confidence interval {CI}]: −1.68 [−2.03 to −1.33]; P<0.0001) and deceleration time (WMD [95% CI]: −12.0 ms [−23.3 to −0.7]; P=0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions.Conclusion MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.

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“…For example, in the TOPCAT trial,15 the annualized mortality rate was 4.4%, I‐PRESERVE16 was 5.2%, whereas in Alberta HEART, the group with HF‐PEF, also recruited as an outpatient but without enriching criteria, was 4%. Because our patients were drawn from an outpatient community, rather than an inhospital or recently hospitalized cohort, this may reflect a lower risk than those from cohorts recruited in hospital 17…”

Section: Discussionmentioning

confidence: 99%

A prospective evaluation of the established criteria for heart failure with preserved ejection fraction using the Alberta HEART cohort

et al. 2017

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AimsHeart failure with a preserved ejection fraction (HF‐PEF) remains a difficult clinical diagnosis. The aim of this study was to test the utility of established criteria to classify patients with HF‐PEF. We prospectively enrolled patients into one of five groups across a spectrum of cardiac disease and applied three different criteria for HF‐PEF and calculated diagnostic metrics.Methods and resultsA total of 565 patients were included in the analysis, including 170 patients with an adjudicated diagnosis of HF‐PEF, 152 patients with heart failure with reduced ejection fraction, 152 patients at risk for heart failure, and 91 age‐matched healthy controls. For the diagnosis of HF‐PEF, the positive likelihood ratios were 6.1, 6.9, and 4.8 for the Zile, European Society of Cardiology (ESC) 2007, and ESC 2016 criteria, respectively. The negative likelihood ratios were 0.58, 0.60, and 0.42 for the Zile, ESC 2007, and ESC 2016 criteria, respectively. All three criteria lacked sensitivity to detect HF‐PEF (46.5%, 44.1%, and 51.8%, respectively) but were highly specific (92.4%, 93.9%, and 89%, respectively). We further evaluated the criteria to distinguish HF‐PEF from other diagnoses after excluding heart failure with reduced ejection fraction; the results were similar.ConclusionsIn this community based cohort, the likelihood ratios of the existing criteria for HF‐PEF were not at the level necessary to be considered diagnostic. Improved criteria for the diagnosis of patients with HF‐PEF are needed.

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Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction

Cited by 1,725 publications

References 35 publications

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

A prospective evaluation of the established criteria for heart failure with preserved ejection fraction using the Alberta HEART cohort

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