Relationship between Pulmonary Artery Stiffness and Functional Capacity in Patients with Heart Failure with Reduced Ejection Fraction

A contemporary review of treatments that have been shown to improve functional capacity in patients with Heart Failure and reduced Ejection Fraction (HFrEF). The improvement of functional capacity is one of the main goals of treatment in patients with HFrEF. In the past, despite significant effects on exercise capacity some drugs (e.g. ibopamine, flosequinan) have shown detrimental effects on long- term outcomes in patients with HFrEF. It is perhaps notable that both of these drugs had shown signals of increased safety concerns during the earlier clinical phases of their development. The challenge is to encourage a timely identification of effective treatments that can enhance functional performance in HF without the more difficult and more expensive path to prove all drugs also reduce mortality. It is valuable to have approved and effective treatments that can do the first without the need for the second in all cases, provided adequate safety can be assured. Ivabradine, trimetazidine, ferric carboxymaltose and diuretics have consistently shown to improve functional capacity and symptoms in patients with HFrEF because of their effect on long term prognosis these drugs should always be considered in patients with heart failure. Diuretics improve functional capacity and should be prescribed in patients with signs and symptoms of congestions. Cardiac resynchronisation therapy improves functional capacity in patients with HFrEF in whom it is appropriately applied (QRS >130/150 msec according to morphology).

Download Full-text

Pulmonary Artery Pressure-Guided Management of Patients With Heart Failure and Reduced Ejection Fraction

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.08.010 ◽

2017 ◽

Vol 70 (15) ◽

pp. 1875-1886 ◽

Cited By ~ 79

Author(s):

Michael M. Givertz ◽

Lynne W. Stevenson ◽

Maria R. Costanzo ◽

Robert C. Bourge ◽

Jordan G. Bauman ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Reduced Ejection Fraction ◽

Artery Pressure ◽

Patients With Heart Failure

Download Full-text

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Journal of Clinical Medicine ◽

10.3390/jcm9103159 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3159

Author(s):

Daniele Masarone ◽

Vittoria Errigo ◽

Enrico Melillo ◽

Fabio Valente ◽

Rita Gravino ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Pulmonary Artery ◽

Right Ventricle ◽

Right Ventricular ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

Background: right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction (HFrEF). Methods: As the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown, this study aimed to analyse the effect of this drug on TAPSE/PASP in patients with HFrEF. We retrospectively analysed all outpatients with HFrEF referred to our unit between October 2016 and July 2018. Results: At the 1-year follow-up, sacubitril/valsartan therapy was associated with a significant improvement in TAPSE (18.26 ± 3.7 vs. 19.6 ± 4.2 mm, p < 0.01), PASP (38.3 ± 15.7 vs. 33.7 ± 13.6, p < 0.05), and RV-PA coupling (0.57 ± 0.25 vs. 0.68 ± 0.30 p < 0.01). These improvements persisted at the 2-year follow-up. In the multivariable analysis, the improvement in the RV-PA coupling was independent of the left ventricular remodelling. Conclusions: in patients with HFrEF, sacubitril/valsartan improved the RV-PA coupling; however, further trials are necessary to evaluate the role of sacubitril/valsartan in the treatment of right ventricle (RV) dysfunction either associated or not associated with left ventricular dysfunction.

Download Full-text