scholarly journals Targeting Endothelial Function to Treat Heart Failure with Preserved Ejection Fraction: The Promise of Exercise Training

2017 ◽  
Vol 2017 ◽  
pp. 1-17 ◽  
Author(s):  
Andreas B. Gevaert ◽  
Katrien Lemmens ◽  
Christiaan J. Vrints ◽  
Emeline M. Van Craenenbroeck
Keyword(s):  
Heart Failure ◽  
Endothelial Dysfunction ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Current Knowledge ◽  
Beta Blockers ◽  
Preserved Ejection Fraction ◽  
Cellular Mechanisms ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction

Although the burden of heart failure with preserved ejection fraction (HFpEF) is increasing, there is no therapy available that improves prognosis. Clinical trials using beta blockers and angiotensin converting enzyme inhibitors, cardiac-targeting drugs that reduce mortality in heart failure with reduced ejection fraction (HFrEF), have had disappointing results in HFpEF patients. A new “whole-systems” approach has been proposed for designing future HFpEF therapies, moving focus from the cardiomyocyte to the endothelium. Indeed, dysfunction of endothelial cells throughout the entire cardiovascular system is suggested as a central mechanism in HFpEF pathophysiology. The objective of this review is to provide an overview of current knowledge regarding endothelial dysfunction in HFpEF. We discuss the molecular and cellular mechanisms leading to endothelial dysfunction and the extent, presence, and prognostic importance of clinical endothelial dysfunction in different vascular beds. We also consider implications towards exercise training, a promising therapy targeting system-wide endothelial dysfunction in HFpEF.

scholarly journals Clinical Utility of Exercise Training in Heart Failure with Reduced and Preserved Ejection Fraction

2015 ◽  
Vol 9 ◽  
pp. CMC.S21372 ◽  
Author(s):  
Muhammad Asrar Ul Haq ◽  
Cheng Yee Goh ◽  
Itamar Levinger ◽  
Chiew Wong ◽  
David L. Hare
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Exercise Tolerance ◽  
Exercise Intolerance ◽  
Sufficient Evidence ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed.

scholarly journals Patterns of Treatment in Patients with Heart Failure with Preserved Ejection Fraction: the REasons for Geographic And Racial Differences in Stroke study

2019 ◽  
Author(s):  
Bharat Poudel ◽  
Matthew S. Loop ◽  
Todd M. Brown ◽  
Raegan W. Durant ◽  
Monika M. Safford ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Racial Differences ◽  
Isosorbide Dinitrate ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Chronic Obstructive ◽  
Preserved Ejection Fraction ◽  
Converting Enzyme Inhibitors ◽  
Pharmacy Claims

AbstractPurposeWe described medication use patterns among REasons for Geographic And Racial Differences in Stroke (REGARDS) participants hospitalized for heart failure with preserved ejection fraction (HFpEF) (152 hospitalizations, 101 unique individuals).MethodsMedication data were obtained from medical record review and Medicare Part D pharmacy claims. We compared discharge medication prescriptions between patients with and without chronic kidney disease (CKD), coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), and diabetes.ResultsThe mean age was 74.8 years, 53.3% were black and 73.7% were female. Hypertension (97.2%), diabetes (65.1%), COPD (51.3%), CKD (41.1%) and history of CHD (60.9%) were common. On admission and discharge, respectively, beta-blockers (66.4%, 72.7%), angiotensin converting enzyme inhibitors or angiotensin receptor blockers (42.8%, 51.7%), diuretics (61.2%, 80.9%), loop diuretics (55.9%, 78.3%), calcium channel blockers (41.0%, 41.2%) and statins (44.7%, 50.3%) were commonly used. Spironolactone, digoxin, hydralazine plus isosorbide dinitrate (HISDN), isosorbide dinitrate alone and aldosterone receptor antagonists were used by <20%. For each medication, prescriptions were more common at discharge than admission. Many participants did not have Medicare claims for filled prescriptions in the year following discharge. A higher percentage of patients with versus without CKD, CHD, and diabetes had discharge prescriptions statins. Participants with CKD were also more likely to receive prescriptions for HISDN.ConclusionBeta-blockers and diuretics were commonly prescribed at admission and discharge among HFpEF, but pharmacy claims for these medications within one-year were substantially less common. The comorbidities CHD, CKD, and diabetes were associated with prescriptions of statins at discharge.

scholarly journals «Grey zone» of heart failure

2018 ◽  
Vol 99 (4) ◽  
pp. 651-656
Author(s):  
P Yu Galin ◽  
S A Kulbaisova ◽  
N Erov
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Research Work ◽  
Epidemiological Studies ◽  
Response To Treatment ◽  
Grey Zone ◽  
Preserved Ejection Fraction ◽  
Aldosterone Antagonists ◽  
Reduced Ejection Fraction

The review is devoted to modern understanding of heart failure with mid-range ejection fraction. The formation of the paradigm of «two phenotypes» of heart failure began around the end of the last century. As a result of a number of large epidemiological studies on heart failure with preserved ejection fraction, so-called «grey zone» of ejection fraction values was formed in the range of about 40-50%. This situation arose because of the lack of clearly established level of normal ejection fraction and underlines imperfection of this parameter as the only classification criterion. But no more convenient «tool» for research work was offered. In the past decade, «grey zone» of heart failure has been actively explored by clinical epidemiologists and clinicians. Should we classify these patients as one of the existing phenotypes of heart failure or present them as a new, separate phenotype? Both the first and second decisions require information about the population «portrait» of subgroup, about their response to treatment, and presumptive pathophysiological mechanisms of heart failure. In 2016 European society of cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure, heart failure with mid-range ejection fraction was determined as a separate subgroup to stimulate the search for such data. At the moment mid-range ejection fraction is known to be recorded in about 10-20% of patients with heart failure. They have substantial comorbidities as patients with preserved ejection fraction but the prevalence of ischemic heart disease in this subgroup makes it similar to heart failure with reduced ejection fraction. The response to treatment with beta-blockers and aldosterone antagonists is similar to that of heart failure with reduced ejection fraction. It is important that the mortality rates in all three groups of patients are approximately the same. This circumstance underlines the importance of further searche. Perhaps the research of «grey zone» of the syndrome will help to better understand pathophysiology of the existing heart failure phenotypes and confirm the validity of their identification based on ejection fraction.

scholarly journals Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence

2021 ◽  
Vol 10 (2) ◽  
pp. 203
Author(s):  
Eleni-Evangelia Koufou ◽  
Angelos Arfaras-Melainis ◽  
Sahil Rawal ◽  
Andreas P. Kalogeropoulos
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Current Knowledge ◽  
Systolic Function ◽  
Angiotensin Receptor Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Current Evidence ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction

In this review, we briefly outline our current knowledge on the epidemiology, outcomes, and pathophysiology of heart failure (HF) with mid-range ejection fraction (HFmrEF), and discuss in more depth the evidence on current treatment options for this group of patients. In most studies, the clinical background of patients with HFmrEF is intermediate between that of patients with HF and reduced ejection fraction (HFrEF) and patients with HF and preserved ejection fraction (HFpEF) in terms of demographics and comorbid conditions. However, the current evidence, stemming from observational studies and post hoc analyses of randomized controlled trials, suggests that patients with HFmrEF benefit from medications that target the neurohormonal axes, a pathophysiological behavior that resembles that of HFrEF. Use of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sacubitril/valsartan is reasonable in patients with HFmrEF, whereas evidence is currently scarce for other therapies. In clinical practice, patients with HFmrEF are treated more like HFrEF patients, potentially because of history of systolic dysfunction that has partially recovered. Assessment of left ventricular systolic function with contemporary noninvasive modalities, e.g., echocardiographic strain imaging, is promising for the selection of patients with HFmrEF who will benefit from neurohormonal antagonists and other HFrEF-targeted therapies.

scholarly journals Heart failure with preserved ejection fraction: present status and future directions

2019 ◽  
Vol 51 (12) ◽  
pp. 1-9 ◽  
Author(s):  
Somy Yoon ◽  
Gwang Hyeon Eom
Keyword(s):  
Heart Failure ◽  
Survival Rate ◽  
Animal Models ◽  
Ejection Fraction ◽  
Clinical Features ◽  
Beta Blockers ◽  
Clinical Importance ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Molecular Events

AbstractThe clinical importance of heart failure with preserved ejection fraction (HFpEF) has recently become apparent. HFpEF refers to heart failure (HF) symptoms with normal or near-normal cardiac function on echocardiography. Common clinical features of HFpEF include diastolic dysfunction, reduced compliance, and ventricular hypokinesia. HFpEF differs from the better-known HF with reduced ejection fraction (HFrEF). Despite having a “preserved ejection fraction,” patients with HFpEF have symptoms such as shortness of breath, excessive tiredness, and limited exercise capability. Furthermore, the mortality rate and cumulative survival rate are as severe in HFpEF as they are in HFrEF. While beta-blockers and renin-angiotensin-aldosterone system modulators can improve the survival rate in HFrEF, no known therapeutic agents show similar effectiveness in HFpEF. Researchers have examined molecular events in the development of HFpEF using small and middle-sized animal models. This review discusses HFpEF with regard to etiology and clinical features and introduces the use of mouse and other animal models of human HFpEF.

scholarly journals Phenotypic clusters in heart failure with preserved and mid-range ejection fraction: new data and perspectives

2021 ◽  
Vol 26 (4) ◽  
pp. 4436
Author(s):  
O. V. Tsygankova ◽  
V. V. Veretyuk
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Evidence Base ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
The Impact

The problems of heart failure (HF) are becoming increasingly important every year due to the increasing spread of cardiovascular diseases resulting in its development, as well as the impact of metabolic factors, obesity, drugs and endocrine dysfunctions on the myocardium. Isolation of phenotypes with preserved, mid-ranged and reduced ejection fraction in HF allows ranking the evidence base and identifying groups of patients with preferred drug intervention strategies aimed at achieving the six goals of treating HF patients and, above all, reducing mortality. The results of recent studies have significantly expanded the list of tools for management of HF with reduced ejection fraction (EF), presented today, according to John J. V. McMurray, by five pillars: angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers, angiotensin receptor antagonist/neprilysin inhibitor, beta-blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2). On the other hand, the exceptional heterogeneity of patients with HF with preserved and mid-range EF and a prevailing opinion on the need for a unified therapy for patients with HF with mid-range and reduced EF, along with the absence of proven prognosis-modifying drugs, require the identifying phenotypic clusters of patients for targeted selection of a treatment strategy. This was the subject of interest in this literature review.

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