Noncardiac Comorbidities in Heart Failure With Preserved Ejection Fraction　– A Commonly Ignored Fact –

Abstract

It has been well described that many patients with heart failure (HF) have a normal left ventricular ejection fraction. This entity has been termed "heart failure with preserved ejection fraction (HFPEF)". Significant advances have been made in understanding the clinical characteristics of HFPEF over the past 2 decades on the basis of large HF registries and randomized clinical trials. However, most multicenter clinical trials that investigated medical therapies in HFPEF have yielded disappointing results. HFPEF being a clinical syndrome involving multiple organ systems may be a potential explanation for treatment failure. In this review we discuss the prevalence of noncardiac comorbidities in HFPEF patients as well as their effect on the prognosis of HFPEF. (Circ J 2015; 79: 954 -959)

Hippocampal Blood Flow Abnormality Associated With Depressive Symptoms and Cognitive Impairment in Patients With Chronic Heart Failure

“…42 Non-cardiac comorbidities may be a possible explanation for treatment failure of CHF patients. 43 Thus, it is important to elucidate the mechanism of depression and cognitive impairment, which are the major brain comorbidities of CHF patients. The present study demonstrated that a novel neural substrate, the hippocampus, could explain the association between CHF and depression and cognitive dysfunction.…”

Low-Normal Serum Sodium and Heart Failure-Related Events in Patients With Heart Failure With Preserved Left Ventricular Ejection Fraction

“…11−17 In patients with HFpEF, it has been estimated that approximately only 10-25% of cases of hyponatremia are reported. 14, 18 Several recent clinical studies demonstrated that hyponatremia is an independent predictor of mortality in HFpEF patients and that sNa at admission for acute HF predicted the likelihood of cardiovascular death, with a relative risk for cardiovascular death of 1.08 for each 1-mmol/L decrease. 14, [19][20][21][22][23] In HFpEF patients after treatment according to the guideline, we investigated the prognostic significance of sNa as a continuous variable and low-normal sNa (135 mmol/L<sNa <140 mmol/L) for HF-related clinical events.…”

Fluctuation of Dynamic Diastolic Function Relative to Static Cardiac Structure ― New Insights Into the Underlying Mechanism of Heart Failure With Preserved Ejection Fraction in Elderly Patients ―

“…4-6 The pathophysiological base of HFpEF may be an extreme form of age-related deterioration with ventricular-arterial interrelation, possibly related to the prevalence of noncardiac comorbidities. 7 Regression modeling has identified that changes in cardiac structure, such as greater LV hypertrophy (LVH) and atrial dilation, best distinguish HFpEF from hypertensive LVH without HF. 8 However, the difference between elderly men and women in diastolic function relative to arterial elasticity, and its relation to alterations in the cardiac structure of hypertensive patients, remains unclear.…”