Management Heart Failure with Preserved Ejection Fraction: A Mini Review
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Heart failure (HF) is a complex clinical syndrome that results when heart’s ability to contract or fill is impaired structurally or functionally. Current guideline has been classified HF according to level of left ventricular ejection fraction (EF). 1) Heart failure with reduced ejection fraction (HRrEF): EF ≤ 40%; 2) Heart failure with mildy ejection fraction (HRmrEF): EF 41 - 49%; 3) Heart failure with preserved ejection fraction (HRpEF): EF ≥50%.
AIM: We aimed to analyse the management of heart failure with preserved ejection fraction.
METHODS: We conducted a literature search of relevant articles in various databases (Pubmed & Google Scholar). Articles to include in the review was based on agreement of the authors.
RESULTS: Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of all heart failure cases. HFpEF remains a challenging condition to diagnose given its unclear and often heterogenous etiology with numerous clinical mimics and complex systemic pathophysiology.
CONCLUSION: Additionally, effective treatment modalities are limited with numerous negative clinical trials over the past few decades. In this review, we updated the last knowledge of management HFpEF by reviewing recent guideline and studies.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol.
;14(10):591-602. https://doi.org/10.1038/nrcardio.2017.65 PMid:28492288
Bozkurt B, Coats AJ, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: A report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. 2021;23(3):352-80. https://doi.org/10.1016/j.cardfail.2021.01.022 PMid:33605000
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. https://doi.org/10.1093/eurheartj/ehab368 PMid:34447992
Van Aelst LN, Arrigo M, Placido R, Akiyama E, Girerd N, Zannad F, et al. Acutely decompensated heart failure with preserved and reduced ejection fraction present with comparable haemodynamic congestion. Eur J Heart Fail. 2018;20(4):738-47. https://doi.org/10.1002/ejhf.1050 PMid:29251818
Omote K, Verbrugge FH, Sorimachi H, Omar M, Popovic D, Obokata M, et al. Central haemodynamic abnormalities and outcome in patients with unexplained dyspnoea. Eur J Heart Fail. 2022;387(12):1089-98. https://doi.org/10.1002/ejhf.2747 PMid:36420788
Kumar AA, Gupta DK. Heart failure with preserved ejection fraction. In: Hayes KM, Dellise NR, editors. Managing Heart Failure in Primary Care: A Case Study Approach. Cham: Springer; 2023. https://doi.org/10.1007/978-3-031-20193-6_7
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. AHA/ACC/HFSA Guideline for the management of heart failure: A report of the American college of cardiology/ American heart association joint committee on clinical practice guidelines. Circulation. 2022;145:895-1032. https://doi.org/10.1161/CIR.0000000000001063
Borlaug BA, Sharma K, Shah SJ, Ho JE. Heart failure with preserved ejection fraction: JACC scientific statement. J Am Coll Cardiol. 2023;81(18):1810-34. https://doi.org/10.1016/j.jacc.2023.01.049 PMid:37137592
Desai AS, Lam CS, McMurray JJ, Redfield MM. How to manage heart failure with preserved ejection fraction: Practical guidance for clinicians. JACC Heart Fail. 2023;11(6):619-36. https://doi.org/10.1016/j.jchf.2023.03.011 PMid:37140514
Hibodeau JT, Turer AT, Gualano SK, Ayers CR, Velez- Martinez M, Mishkin JD, et al. Characterization of a novel symptom of advanced heart failure: Bendopnea. JACC Heart Fail. 2014;2(1):24-31. https://doi.org/10.1016/j.jchf.2013.07.009 PMid:24622115
Redfield MM, Borlaug BA. Heart failure with preserved ejection fraction. JAMA 2023;329(10):827-38. https://doi.org/10.1001/jama.2023.2020 PMid:36917048
Reddy YN, Kaye DM, Handoko ML, van de Bovenkamp AA, Tedford RJ, Keck C, et al. Diagnosis of heart failure with preserved ejection fraction among patients with unexplained dyspnea. JAMA Cardiol. 2022;7(9):891-9. https://doi.org/10.1001/jamacardio.2022.1916 PMid:35830183
Jain CC, Borlaug BA. Performance and interpretation of invasive hemodynamic exercise testing. Chest. 2020;158(5):2119-29. https://doi.org/10.1016/j.chest.2020.05.552 PMid:32473950
Solomon SD, Rizkala AR, Lefkowitz MP, Shi VC, Gong JJ, Anavekar N, et al. Baseline characteristics of patients with heart failure and preserved ejection fraction in the PARAGON-HF trial. Circ Heart Fail. 2018;11(7):e004962. https://doi.org/10.1161/CIRCHEARTFAILURE.118.004962 PMid:29980595
Costanzo MR, Stevenson LW, Adamson PB, Desai AS, Heywood JT, Bourge RC, et al. Interventions linked to decreased heart failure hospitalizations during ambulatory pulmonary artery pressure monitoring. J Am Coll Cardiol Heart Fail. 2016;4(5):333-44. https://doi.org/10.1016/j.jchf.2015.11.011 PMid:26874388
Teramoto K, Teng TH, Chandramouli C, Tromp J, Sakata Y, Lam CS. Epidemiology and clinical features of heart failure with preserved ejection fraction. Card Fail Rev. 2022;8:e27. https://doi.org/10.15420/cfr.2022.06 PMid:35991117
Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71. https://doi.org/10.1016/j.jacc.2013.02.092 PMid:23684677
Kawano H, Fuiwara A, Kai H, Kumagai E, Okamoto R, Shibata R, et al. Effects of blood pressure lowering in patients with heart failure with preserved ejection fraction: A systematic review and meta-analysis. Hypertens Res. 2019;42(4):504-13. https://doi.org/10.1038/s41440-019-0216-8 PMid:30948821
Kristensen SL, Jhund PS, Lee MM, Køber L, Solomon SD, Granger CB, et al. Prevalence of prediabetes and undiagnosed diabetes in patients with HFpEF and HFrEF and associated clinical outcomes. Cardiovasc Drugs Ther. 2017;31(5-6):545-9. https://doi.org/10.1007/s10557-017-6754-x PMid:28948430
Lam CS. Diabetic cardiomyopathy: An expression of stage B heart failure with preserved ejection fraction. Diab Vasc Dis Res.
;12(4):234-8. https://doi.org/10.1177/1479164115579006 PMid:25908570
Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-61. https://doi.org/10.1056/NEJMoa2107038 PMid:34449189
Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, et al. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: A randomized clinical trial. JAMA. 2016;315(1):36-46. https://doi.org/10.1001/jama.2015.17346 PMid:26746456
Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, et al. Physical rehabilitation for older patients hospitalized for heart failure. N Engl J Med. 2021;385(3):203216. https://doi.org/10.1056/NEJMoa2026141
Lam CS, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011;13(1):18-28. https://doi.org/10.1093/eurjhf/hfq121 PMid:20685685
Vaduganathan M, Piccini JP, Camm AJ, Crijns HJ, Anker SD, Butler J, et al. Dronedarone for the treatment of atrial fibrillation with concomitant heart failure with preserved and mildly reduced ejection fraction: A post-hoc analysis of the ATHENA trial. Eur J Heart Fail. 2022;24(6):1094-101. https://doi.org/10.1002/ejhf.2487 PMid:35293087
Packer DL, Piccini JP, Monahan KH, Al-Khalidi HR, Silverstein AP, Noseworthy PA, et al. Ablation versus drug therapy for atrial fibrillation in heart failure: Results from the CABANA trial. Circulation. 2021;143(14):1377-90. https://doi.org/10.1161/CIRCULATIONAHA.120.050991 PMid:33554614
Vaduganathan M, Docherty DF, Claggett BL, Jhund PS, de Boer RA, Hernandez AF, et al. SGLT-2 inhibitors in patients with heart failure: A comprehensive meta-analysis of five randomised controlled trials. Lancet. 2022;400(10354):757-67. https://doi.org/10.1016/S0140-6736(22)01429-5 PMid:36041474
Solomon SD, McMurray JJ, Claggett B, de Boer RA, DeMets D, Hernandez AF, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-98. https://doi.org/10.1056/NEJMoa2206286 PMid:36027570
Solomon SD, McMurray JJ,Anand IS, Ge J, Lam CS, MaggioniAP, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-20. https://doi.org/10.1056/NEJMoa1908655 PMid:31475794
Solomon SD, Vaduganathan M, Claggett BL, Packer M, Zile M, Swedberg K, et al. Sacubitril/valsartan across the spectrum of ejection fraction in heart failure. Circulation 2020;141(5):352-61. https://doi.org/10.1161/CIRCULATIONAHA.119.044586 PMid:31736342
Pfeffer MA, Claggett B, Assmann SF, Boineau R, Anand IS, Clausell N, et al. Regional variation in patients and outcomes in the treatment of preserved cardiac function heart failure with an aldosteroneantagonist(TOPCAT)trial.Circulation.2015;131(1):34-42. https://doi.org/10.1161/CIRCULATIONAHA.114.013255 PMid:25406305
Solomon SD, Claggett B, Lewis EF, Desai A, Anand I, Sweitzer NK, et al. Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J. 2016;37(5):455-62. https://doi.org/10.1093/eurheartj/ehv464 PMid:26374849