Treatment of Heart Failure With Preserved Ejection Fraction: Have We Been Pursuing the Wrong Paradigm?

Oghlakian, Gerard; Sipahi, İlke; Fang, James C.

doi:10.4065/mcp.2010.0841

Cited by 44 publications

(31 citation statements)

References 59 publications

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“…Hallmarks of diastolic dysfunction include left atrial enlargement, elevated E / e ′ ratio [the peak mitral velocity of early filling ( E ) divided by early diastolic mitral annular velocity ( e ′)], left ventricular hypertrophy, and elevated circulating natriuretic peptides 1, 2, 3. The pathological changes in the left ventricle (LV) include myocyte hypertrophy, apoptosis, necrosis, and excessive interstitial collagen deposition in the myocardium 4.…”

Section: Introductionmentioning

confidence: 99%

Autonomic regulation therapy to enhance myocardial function in heart failure patients: the ANTHEM‐HFpEF study

et al. 2017

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BackgroundApproximately half of the patients presenting with new‐onset heart failure (HF) have HF with preserved left ventricular ejection fraction (HFpEF) and HF with mid‐range left ventricular ejection fraction (HFmrEF). These patients have neurohormonal activation like that of HF with reduced ejection fraction; however, beta‐blockers and angiotensin‐converting enzyme inhibitors have not been shown to improve their outcomes, and current treatment for these patients is symptom based and empiric. Sympathoinhibition using parasympathetic stimulation has been shown to improve central and peripheral aspects of the cardiac nervous system, reflex control, induce myocyte cardioprotection, and can lead to regression of left ventricular hypertrophy. Beneficial effects of autonomic regulation therapy (ART) using vagus nerve stimulation (VNS) have also been observed in several animal models of HFpEF, suggesting a potential role for ART in patients with this disease.MethodsThe Autonomic Neural Regulation Therapy to Enhance Myocardial Function in Patients with Heart Failure and Preserved Ejection Fraction (ANTHEM‐HFpEF) study is designed to evaluate the feasibility, tolerability, and safety of ART using right cervical VNS in patients with chronic, stable HFpEF and HFmrEF. Patients with symptomatic HF and HFpEF or HFmrEF fulfilling the enrolment criteria will receive chronic ART with a subcutaneous VNS system attached to the right cervical vagus nerve. Safety parameters will be continuously monitored, and cardiac function and HF symptoms will be assessed every 3 months during a post‐titration follow‐up period of at least 12 months.ConclusionsThe ANTHEM‐HFpEF study is likely to provide valuable information intended to expand our understanding of the potential role of ART in patients with chronic symptomatic HFpEF and HFmrEF.

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Section: Introductionmentioning

confidence: 99%

Autonomic regulation therapy to enhance myocardial function in heart failure patients: the ANTHEM‐HFpEF study

et al. 2017

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“…impaired relaxation), the 2 syndromes (commonly referred to HF with reduced EF [HFrEF] or preserved EF [HFpEF]) are clearly distinct [8][9][10]. As mentioned earlier, while obesity is a risk factor for cardiac disease, obesity is much more closely linked to HFpEF (diastolic HF) than HFrEF, especially in younger or middle-aged adults, so that it is unlikely to have HFpEF without obesity.…”

mentioning

confidence: 96%

“…Although the prognosis of HF is related to the degree of reduction in LVEF, HFpEF is not a benign disease, and it has a quite unfavorable prognosis (not much different than HF with reduced LVEF) and a particular resistance to conventional treatments [10].…”

mentioning

confidence: 99%

Obesity and Diastolic Heart Failure: Is Inflammation the Link?

Carbone¹

2013

Transl Med

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“…Perindopril showed improvement in exercise capacity, and candesartan decreased hospitalisations for HF; however, irbesartan showed no benefit in either improving quality of life or decreasing hospitalisations for HF. [25] Thus, data collected so far suggest therapy with RAAS antagonists for HFpEF/HFmrEF only in presence of comorbidities such as hypertension, diabetes mellitus, or coronary artery disease. [25,26] …”

Section: Treatment Of Comorbidities In Hfpef/hfmrefmentioning

confidence: 99%

“…[25] Thus, data collected so far suggest therapy with RAAS antagonists for HFpEF/HFmrEF only in presence of comorbidities such as hypertension, diabetes mellitus, or coronary artery disease. [25,26] …”

Section: Treatment Of Comorbidities In Hfpef/hfmrefmentioning

confidence: 99%

Approach to the Treatment of Heart Failure With Preserved Ejection Fraction and Mid- Range Ejection Fraction

Jankowska¹,

Coats²,

Anker³

2017

ICFJ

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In this article we discuss the treatment of heart failure (HF) with preserved ejection fraction (HFpEF) and of HF with mid-range ejection fraction (HFmrEF) as has received considerable interest since the publciation of the 2016 European Society of Cardiology (ESC) heart failure guidelines. Since clinical trials on HFpEF have included also patients with HFmrEF, due to the lack of an agreed definition, the ESC recommendations here described apply to both phenotypes. As a consequence of the recent characterisation of this HF syndrome, it is expected that upcoming research will provide data specifically regarding HFmrEF and tailored recommendations will be developed in the future.

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Treatment of Heart Failure With Preserved Ejection Fraction: Have We Been Pursuing the Wrong Paradigm?

Cited by 44 publications

References 59 publications

Autonomic regulation therapy to enhance myocardial function in heart failure patients: the ANTHEM‐HFpEF study

Autonomic regulation therapy to enhance myocardial function in heart failure patients: the ANTHEM‐HFpEF study

Obesity and Diastolic Heart Failure: Is Inflammation the Link?

Approach to the Treatment of Heart Failure With Preserved Ejection Fraction and Mid- Range Ejection Fraction

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