Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF

Rosano, Giuseppe M.C.; Vitale, Cristiana; Spoletini, Ilaria

doi:10.36628/ijhf.2023.0058

Int J Heart Fail

2024

DOI: 10.36628/ijhf.2023.0058

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Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF

Giuseppe M.C. Rosano,

Cristiana Vitale,

Ilaria Spoletini

Abstract: Heart failure with mid-range ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) represent over half of heart failure cases but lack proven effective therapies beyond sodium-glucose cotransporter 2 inhibitor and diuretics. HFmrEF and HFpEF are heterogeneous conditions requiring precision phenotyping to enable tailored therapies. This review covers concepts on precision medicine approaches for HFmrEF and HFpEF. Areas discussed include HFmrEF mechanisms, anti-inflammatory and antifibrotic treatmen… Show more

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Cited by 5 publications

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“… 4) However, numerous studies have failed to demonstrate the benefits of HR reduction in patients with HFpEF. 5 6) Conversely, chronotropic incompetence is considered a major pathophysiologic mechanism in HFpEF, 7) and BBs can worsen symptoms and exercise capacity. Moreover, there is evidence that increasing HR through atrial pacing in an HFpEF population can reduce left ventricular end-diastolic filling pressure.…”

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confidence: 99%

Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation: Are Beta-Blockers Still Relevant?

Hyun

2024

Int J Heart Fail

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confidence: 99%

Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation: Are Beta-Blockers Still Relevant?

Hyun

2024

Int J Heart Fail

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Prognostic impact of beta‐blocker use by N‐terminal pro‐brain natriuretic peptide level in acute heart failure patients

Kim,

Ann,

Park

et al. 2024

ESC Heart Failure

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AimsBoth patients with heart failure (HF) with reduced ejection fraction (HFrEF) and those with HF with preserved ejection fraction (HFpEF) present with elevated N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and have multiple comorbidities; consequently, the prognostic effect of NT‐proBNP according to beta‐blocker (BB) use is unknown.MethodsThis retrospective study evaluated patients admitted for acute HF between January 2012 and December 2017 at Ulsan University Hospital. Clinical, echocardiographic, laboratory and drug prescription data, including BB data, were collected from the hospital database. Information on mortality was collected by reviewing medical records or using national death data.ResultsOf the 472 patients evaluated, 216 (45.8%) and 256 (54.2%) patients were and were not prescribed BB at discharge, respectively. A total of 224 (47.5%) patients died within a median follow‐up duration of 44 months. The Kaplan–Meier analysis showed reduced all‐cause mortality with BB in HFrEF (ejection fraction ≤ 40%) but not in HFpEF (ejection fraction > 40%). In the multivariate Cox regression analysis, transmitral to tissue Doppler imaging, early diastolic velocity ratio (E/E′), NT‐proBNP and BB use were independent predictors of all‐cause mortality in HFrEF. Meanwhile, haemoglobin and NT‐proBNP levels were independent predictors of HFpEF. The NT‐proBNP cut‐off value for determining all‐cause mortality was set to 4800 pg/mL. Among HFrEF patients with NT‐proBNP < 4800 pg/mL, the survival rate was higher for patients with BB use than those with no BB use (log‐rank P < 0.001). However, in the HFpEF group, the survival rate associated with BB use did not differ according to the NT‐proBNP levels. Both HFrEF and HFpEF patients with NT‐proBNP levels of ≥4800 pg/mL presented with multiple comorbidities, including lower body mass index and haemoglobin levels and higher creatinine levels, NT‐proBNP levels and E/E′.ConclusionIn patients with acute HF, BB use is associated with reduced all‐cause mortality in those with HFrEF but not in those with HFpEF. HFrEF patients with NT‐proBNP levels of <4800 pg/mL treated with BB have a higher survival rate than those not treated with BB. However, this benefit is not seen in HFrEF patients with NT‐proBNP levels of ≥4800 pg/mL or in all HFpEF patients, regardless of the NT‐proBNP level. NT‐proBNP levels are elevated in multiple comorbid conditions, and these comorbidities may contribute to the attenuated effects of BB on all‐cause mortality.

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Two-year clinical outcome of patients with mildly reduced ejection fraction after acute myocardial infarction: insights from the prospective KAMIR-NIH Registry

Jeon,

Lee,

Moon

et al. 2024

Front. Cardiovasc. Med.

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BackgroundLeft ventricular ejection fraction (LVEF) is a crucial prognostic indicator of acute myocardial infarction (AMI). However, there is a lack of studies on the clinical characteristics and prognosis of patients with mildly reduced ejection fraction (EF) after AMI.MethodsWe categorized 6,553 patients with AMI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) between November 2011 and December 2015 into three groups based on their EF, as assessed by echocardiography during index hospitalization: reduced EF (LVEF ≤40%), mildly reduced EF (LVEF 41%–49%), and preserved EF (LVEF ≥50%). The primary outcome was all-cause death within 2 years. The secondary outcomes included myocardial infarction (MI), revascularization, and patient-oriented composite endpoint (POCE), which was defined as a composite of all-cause death, any MI, or revascularization.ResultsOf the total 6,553 patients, 884 (13.5%) were classified into the reduced EF group, 1,749 (26.7%) into the mildly reduced EF group, and 3,920 (59.8%) into the preserved EF group. Patients with mildly reduced EF exhibited intermediate mortality (reduced EF, 24.7%; mildly reduced EF, 8.3%; preserved EF, 4.6%; p < 0.0001), MI (3.9% vs. 2.7% vs. 2.6%; p < 0.0046), and POCE (33.0% vs. 15.6% vs. 12.4%; p < 0.0001) rates, albeit closer to those of the preserved EF. After adjustment for demographics, risk factors, admission status, and discharge medications, patients with mildly reduced EF showed a lower risk of all-cause death than those with reduced EF (mildly reduced EF group as a reference: HR, 1.74; 95% CI, 1.40–2.18; p < 0.001), but it did not differ significantly from those with preserved EF (HR, 0.94; 95% CI, 0.75–1.18; p = 0.999)ConclusionsOver a 2-year follow-up period, patients with AMI and mildly reduced EF demonstrated better prognoses than those with reduced EF, but did not differ significantly from those with preserved EF. Clinical Trial Registrationcris.nih.go.kr, identifier: KCT−0000863.

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Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF

Cited by 5 publications

References 56 publications

Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation: Are Beta-Blockers Still Relevant?

Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation: Are Beta-Blockers Still Relevant?

Prognostic impact of beta‐blocker use by N‐terminal pro‐brain natriuretic peptide level in acute heart failure patients

Two-year clinical outcome of patients with mildly reduced ejection fraction after acute myocardial infarction: insights from the prospective KAMIR-NIH Registry

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