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Tang F, Han H, Fu S, Liu Q, Zhou S, Huang J, Xiao Y. Nonpharmacological Approaches to Managing Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2024; 17:e011269. [PMID: 38887946 PMCID: PMC11332382 DOI: 10.1161/circheartfailure.123.011269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/29/2024] [Indexed: 06/20/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a common subtype of heart failure marked by impaired left ventricular diastolic function and decreased myocardial compliance. Given the limited availability of evidence-based pharmacological treatments for HFpEF, there is a growing interest in nonpharmacological interventions as viable therapeutic alternatives. This review aims to explore the pathophysiology of HFpEF and present recent advancements in nonpharmacological management approaches, encompassing noninvasive therapies, invasive procedures and targeted treatments for comorbidities. An extensive literature review was undertaken to identify and synthesize emerging nonpharmacological treatment options for HFpEF, assessing their potential to enhance patient outcomes. Nonpharmacological strategies, such as vagus nerve stimulation, percutaneous pulmonary artery denervation, renal denervation, transcatheter insertion of atrial shunts and pericardial resection, demonstrate promising potential for alleviating HFpEF symptoms and improving patient prognosis. Moreover, addressing comorbidities, such as hypertension and diabetes, may offer additional therapeutic benefits. These cutting-edge techniques, in conjunction with well-established exercise therapies, pave the way for future research and clinical applications in the field. Nonpharmacological interventions hold promise for advancing HFpEF patient care and fostering a deeper understanding of these treatment approaches, which will facilitate new clinical applications and contribute to the development of more targeted therapies.
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Affiliation(s)
- Feiyang Tang
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
- Xiangya School of Medicine (F.T., H.H.), Central South University, Changsha, China
| | - Haofu Han
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
- Xiangya School of Medicine (F.T., H.H.), Central South University, Changsha, China
| | - Sheng Fu
- Division of Cardiovascular Medicine, Department of Medicine (S.F.), University of Louisville, KY
| | - Qiming Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine (J.H.), University of Louisville, KY
| | - Yichao Xiao
- Department of Cardiovascular Medicine, Second Xiangya Hospital (F.T., H.H., Q.L., S.Z., Y.X.), Central South University, Changsha, China
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Johny D, Subramanyam K, Bhandary RM, Rao A. Non-surgical treatment of Lutembacher syndrome: combined percutaneous transcatheter therapy. BMJ Case Rep 2022; 15:e247984. [PMID: 35584855 PMCID: PMC9119157 DOI: 10.1136/bcr-2021-247984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/03/2022] Open
Abstract
A woman in her 30s presented with progressive worsening of dyspnoea for 6 months. On evaluation, she was diagnosed with severe rheumatic mitral stenosis (mitral valve area of 0.6 cm2) and a large ostium secundum atrial septal defect (21 mm) with a left to right shunt and severe pulmonary artery hypertension. She was diagnosed with Lutembacher syndrome and was evaluated for suitability of a percutaneous approach. She was subjected to a combined procedure of percutaneous transluminal mitral commissurotomy followed by device closure of the atrial septal defect. The patient tolerated the procedure, remained haemodynamically stable and was discharged after 4 days. This procedure can prevent the morbidity and mortality associated with anaesthesia and cardiac surgery and the psychological trauma of a thoracotomy scar particularly in a female patient, as well as obviate the need for prolonged hospital stay.
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Affiliation(s)
- Dilip Johny
- Cardiology, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | | | - Ram Mohan Bhandary
- Internal Medicine, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Amita Rao
- Periodontology, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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