scholarly journals Pharmacological Tuning of Adenosine Signal Nuances Underlying Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 12 ◽  
Author(s):  
Alexandrina Campos-Martins ◽  
Bruno Bragança ◽  
Paulo Correia-de-Sá ◽  
Ana Patrícia Fontes-Sousa
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Events ◽  
Developed Countries ◽  
Signalling Pathways ◽  
Evidence Based ◽  
Preserved Ejection Fraction ◽  
Membrane Bound ◽  
Therapeutic Recommendations ◽  
Animal Tests

Heart failure with preserved ejection fraction (HFpEF) roughly represents half of the cardiac failure events in developed countries. The proposed ‘systemic microvascular paradigm’ has been used to explain HFpHF presentation heterogeneity. The lack of effective treatments with few evidence-based therapeutic recommendations makes HFpEF one of the greatest unmet clinical necessities worldwide. The endogenous levels of the purine nucleoside, adenosine, increase significantly following cardiovascular events. Adenosine exerts cardioprotective, neuromodulatory, and immunosuppressive effects by activating plasma membrane-bound P1 receptors that are widely expressed in the cardiovascular system. Its proven benefits have been demonstrated in preclinical animal tests. Here, we provide a comprehensive and up-to-date critical review about the main therapeutic advantages of tuning adenosine signalling pathways in HFpEF, without discounting their side effects and how these can be seized.

Abstract 14489: Physician Perspectives on the Diagnosis and Management of Heart Failure With Preserved Ejection Fraction (HFpEF)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michelle Padarath ◽  
Daniel Ngui ◽  
Justin Ezekowitz ◽  
Michelle Padarath ◽  
Alan Bell
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Ejection Fraction ◽  
Primary Care Physicians ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Evidence Based ◽  
Preserved Ejection Fraction ◽  
Diagnosis And Management ◽  
Evidence Based Treatments

Introduction: Heart failure with preserved ejection fraction (HFpEF) carries high morbidity and mortality. Compared to heart failure with reduced ejection fraction (HFrEF), HFpEF is more difficult to diagnose and lacks in evidence-based treatments. We assessed the perceptions of CV specialists and primary care physicians (PCP) regarding HFpEF diagnosis and management. Methods: The online survey targeted 200 specialists and 200 (PCPs), offering a token honorarium. A total of 159 cardiologists (C), 59 internists (I), and 200 PCPs completed the survey. Results: All provinces were represented. The perceived prevalence of HFpEF vs HFrEF was similar across physician types (58% HFrEF, 42% HFpEF). Roughly 25% of PCPs did not differentiate between HF types. All physician types ranked symptom and mortality reduction as treatment priorities. The majority of specialists felt that HFpEF is best co-managed by primary and specialty care. One fifth of PCPs felt that HFpEF should be managed by primary care alone. Compared to specialists, PCPs were more likely to underestimate HFpEF mortality vs. HFrEF, less aware of gender differences, and less able to identify clinical findings of HFpEF vs. HFrEF. Fewer PCPs (33%) than specialists (50%) use natriuretic peptide (NP) levels for diagnosis, with PCPs expressing more uncertainty with NP utility. All physician types listed cost and limited availability as restrictions to use of NP testing. For evidence-based treatments in HF (ACEi/ARB, beta blockers, loop diuretics, mineralocorticoid receptor antagonists), >50% of PCPs incorrectly identified all agents as effective for HFpEF, with <10% stating that none improved outcomes. Cardiologists were more likely than internists to identify the lack of evidence-based treatments. Conclusions: This survey reveals substantial knowledge and treatment gaps in the diagnosis and management of HFpEF, specifically amongst PCPs. Given the prevalence of HFpEF in primary care, and its substantial morbidity and mortality, strategies are required to reduce these gaps. All physician types recognized the need for increased availability of NP testing for HFpEF diagnosis.

scholarly journals Long-term Prognostic Value of Estimated Plasma Volume in Heart Failure with Preserved Ejection Fraction

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chen-Yu Huang ◽  
Ting-Tse Lin ◽  
Yi-Fan Wu ◽  
Fu-Tien Chiang ◽  
Cho-Kai Wu
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Plasma Volume ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Cardiovascular Outcomes ◽  
Preserved Ejection Fraction ◽  
Heart Failure Hospitalization ◽  
Kaplan Meier

Abstract Plasma volume, estimated by several indirect methods, has been viewed as a biological surrogate for intravascular fluid status. The clinical implication of estimated plasma volume status (ePVS) for long term outcomes in heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigate the prognostic value of ePVS calculated by Strauss formula and its association with cardiovascular events and mortality in a prospective HFpEF cohort. There were 449 individuals met the inclusion criteria of our cohort. Estimated plasma volume variation (ΔePVS) and its instantaneous derivatives were calculated by the Strauss formula. Our study endpoints were events of heart failure hospitalization and mortality. Kaplan–Meier estimates and Cox regression analysis were applied to determine the power of ΔePVS and baseline ePVS in predicting long term cardiovascular outcomes. Both baseline ePVS and ΔePVS were independent predictors of heart failure hospitalization and mortality. Kaplan-Meier estimates of these outcomes stratified by optimal cut-off value showed that HFpEF individuals with higher baseline ePVS and ΔePVS were associated with elevated risk of composite endpoint of heart failure hospitalization and mortality. This study demonstrated the prognostic value of a novel biological surrogate, instantaneous derivatives ePVS, in predicting long term cardiovascular outcomes in HFpEF population. Monitoring instantaneous plasma volume may assist in identifying patients at high risk for future cardiovascular events. Further prospective studies validating the role of ePVS in predicting long-term prognosis in patients with HFpEF are warranted.

scholarly journals Association of Body-Weight Fluctuation With Outcomes in Heart Failure With Preserved Ejection Fraction

2021 ◽  
Vol 8 ◽  
Author(s):  
Yi Li ◽  
Yuan Yu ◽  
Yuzhong Wu ◽  
Weihao Liang ◽  
Bin Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Body Weight ◽  
Ejection Fraction ◽  
Cardiovascular Events ◽  
High Variability ◽  
Preserved Ejection Fraction ◽  
Aldosterone Antagonist ◽  
Weight Fluctuation ◽  
Increased Risk

Aims: To investigate the relationship between body-weight fluctuation and risks of clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF).Methods and Results:We measured intra-individual variations in body weight from baseline and follow-up visits in 1,691 participants with HFpEF from the Americas from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. The primary endpoint was any cardiovascular events (a composite of death from cardiovascular disease, non-fatal myocardial infarction, aborted cardiac arrest, or hospitalization for HF). The body-weight fluctuation was measured according to average successive variability and high variability was defined as greater than or equal to the median. After adjustment for risk factors, mean body weight and weight change, each increase of 1 standard deviation in body-weight variability was significantly associated with increased risks of any cardiovascular events (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.15–1.33, P &lt; 0.001). Patients with high variability had a 47% increased risk of any cardiovascular events and 27% increased risk of all-cause death compared with those with low variability. Such association was similar among patients with New York Heart Association functional class I/II vs. III/IV, obesity vs. non-obesity, and weight loss, gain vs. stability (the P-values for interaction were all insignificant).Conclusion: Among patients with HFpEF, body-weight fluctuation was associated with increased risks of cardiovascular events independent of traditional cardiovascular risk factors, and regardless of HF severity, baseline weight or weight change direction.Clinical Trial Registration: Aldosterone antagonist therapy for adults with heart failure and preserved systolic function (TOPCAT), https://clinicaltrials.gov, identifier [NCT00094302].

scholarly journals Influence of Previous Heart Failure Hospitalization on Cardiovascular Events in Patients With Reduced and Preserved Ejection Fraction

2014 ◽  
Vol 7 (4) ◽  
pp. 590-595 ◽  
Author(s):  
Natalie A. Bello ◽  
Brian Claggett ◽  
Akshay S. Desai ◽  
John J.V. McMurray ◽  
Christopher B. Granger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Events ◽  
Preserved Ejection Fraction ◽  
Heart Failure Hospitalization
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