Practical management of heart failure with preserved ejection fraction. A modest proposal

Jondeau, Guillaume; Arnoult, Florence; Caligiuri, Giuseppina; Phan, G.; Charles, J; Morgant, C; Aumont, Marie Claude

doi:10.1016/j.acvd.2013.04.005

Cited by 2 publications

(4 citation statements)

References 14 publications

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“…The medical knowledge is poor and no specific treatments have been shown to reduce mortality. There are only expert opinions for the management of this pathology 1,36. Both in the development population and in the validation population, the incidence of HFpEF is more frequent than HFrEF,12 which is similar to findings in the literature.…”

Section: Discussionsupporting

confidence: 68%

<p>The prognosis of patients hospitalized with a first episode of heart failure, validation of two scores: PREDICE and AHEAD</p>

Ruiz‐Ruiz¹,

Orenga²,

Medrano³

et al. 2019

CLEP

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Purpose Heart failure (HF) is a chronic, frequent and disabling condition but with a modifiable course and a large potential for improving. The aim of this study was to validate the two available clinical prediction rules for mortality at one year in patients with primo-hospitalization for decompensated HF: PREDICE and AHEAD. The secondary aim was to evaluate in our setting the changes in the clinical pattern of HF in the last decade in patients hospitalized for a first episode of the disease. Patients and methods A prospective multicenter cohort study, which included 180 patients hospitalized with “de novo” HF was conducted to validate the PREDICE score. Calibration and discrimination measurements were calculated for the PREDICE model and the PREDICE score (using the validation cohort of the PREDICE) and the AHEAD score (using both the development and the validation cohort of the PREDICE). Results For the PREDICE models, the area under the curve (AUC) was 0.68 (95% confidence interval [CI]: 0.57–0.79) and the calibration slope 0.65 (95% CI: 0.21–1.20). For the PREDICE score AUC was 0.59 (95% CI: 0.47–0.71) and slope 0.42 (95% CI: −0.20–1.17). For the AHEAD score the AUC was 0.68 (95% CI: 0.62–0.73) and slope 1.38 (95% CI: 0.62–0.73) when used the development cohort of PREDICE and the AUC was 0.58 (95% CI: 0.49–0.67), and slope 0.68 (95% CI: −0.06 to 1.47) when used its validation cohort. Conclusion The present study shows that the two risk scores available for patients with primo-hospitalization for decompensated HF (PREDICE and AHEAD) are not currently valid for predicting mortality at one-year. In our setting the clinical spectrum of hospitalized patients with new-onset HF has been modified over time. The study underscores the need to validate the prognostic models before clinical implementation.

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Section: Discussionsupporting

confidence: 68%

<p>The prognosis of patients hospitalized with a first episode of heart failure, validation of two scores: PREDICE and AHEAD</p>

Ruiz‐Ruiz¹,

Orenga²,

Medrano³

et al. 2019

CLEP

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“…This is supported by the fact that stiffness does not appear only in left ventricle [109]. Myocardial remodelling in HFpEF differs from HFrEF, where remodelling is driven by loss of cardiomyocytes [109].…”

Section: Emerging Treatmentssupporting

confidence: 48%

“…Recently, a new HFpEF paradigm has been proposed, with emphasis shifting from LV afterload excess to coronary microvascular inflammation [109]. This is supported by the fact that stiffness does not appear only in left ventricle [109].…”

Section: Emerging Treatmentsmentioning

confidence: 72%

“…Myocardial remodelling in HFpEF differs from HFrEF, where remodelling is driven by loss of cardiomyocytes [109]. The new HFpEF paradigm proposes that comorbidities, plasma markers of inflammation and vascular hyperaemic responses should be included in diagnostic algorithms and intends to restore myocardial PKG activity with NO-donors, phosphodiesterase 5 inhibitors, and statins [109].…”

Section: Emerging Treatmentsmentioning

confidence: 99%

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Stiff Heart and Stiff Arteries. Could We Soften Both?

Athyros¹,

Τζιόμαλος²,

Farganis³

et al. 2013

TOHYPERJ

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Abstract:Old age, female gender, hypertension (HTN), cardiac ischaemia, and arterial stiffness (AS) are the main determinants of a stiff heart, diastolic dysfunction (DD), and finally heart failure with preserved ejection fraction (HFpEF); however, several cardiac or extra-cardiac pathologies may also be involved. The combined ventricular-arterial stiffening (abnormal left ventricle-arterial coupling) is the main determinant of the increased prevalence of HFpEF in elderly persons, particularly women, and in younger subjects with HTN. Hospitalization and mortality rates in patients with HFpEF are similar to those of patients with heart failure with reduced EF (HFrEF). However, although the prognosis of HFrEF has improved over time, the optimal treatment of HFpEF remains unclear, because of the differences in the pathophysiology of the two syndromes. A number of new drugs have shown promise but they will not be commercially available for several years. For the time being, aggressive treatment of non-cardiac comorbidities is the only option available for the management of HFpEF. Treatment of anaemia, sleep disorders, chronic kidney disease, non-alcoholic fatty liver disease, atrial fibrillation, diabetes mellitus, and judicious use of diuretics are effective to some degree. Statin treatment deserves special attention, regardless of the presence of dyslipidaemia, because it has been shown, mainly in small studies, post hoc analyses, and in a large recent meta-analysis, that it is related to an improved quality of life and a reduction in HF-related mortality. We urgently need to utilize these recourses to relieve a substantial number of patients suffering from HFpEF, a disease with an ominous prognosis.

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Practical management of heart failure with preserved ejection fraction. A modest proposal

Cited by 2 publications

References 14 publications

<p>The prognosis of patients hospitalized with a first episode of heart failure, validation of two scores: PREDICE and AHEAD</p>

<p>The prognosis of patients hospitalized with a first episode of heart failure, validation of two scores: PREDICE and AHEAD</p>

Stiff Heart and Stiff Arteries. Could We Soften Both?

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