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Patel AH, Natarajan B, Pai RG. Current Management of Heart Failure with Preserved Ejection Fraction. Int J Angiol 2022; 31:166-178. [PMID: 36157094 PMCID: PMC9507602 DOI: 10.1055/s-0042-1756173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) encompasses nearly half of heart failure (HF) worldwide, and still remains a poor prognostic indicator. It commonly coexists in patients with vascular disease and needs to be recognized and managed appropriately to reduce morbidity and mortality. Due to the heterogeneity of HFpEF as a disease process, targeted pharmacotherapy to this date has not shown a survival benefit among this population. This article serves as a comprehensive historical review focusing on the management of HFpEF by reviewing past, present, and future randomized controlled trials that attempt to uncover a therapeutic value. With a paradigm shift in the pathophysiology of HFpEF as an inflammatory, neurohormonal, and interstitial process, a phenotypic approach has increased in popularity focusing on the treatment of HFpEF as a systemic disease. This article also addresses common comorbidities associated with HFpEF as well as current and ongoing clinical trials looking to further elucidate such links.
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Affiliation(s)
- Akash H. Patel
- Department of Internal Medicine, University of California Irvine Medical Center, Orange, California
| | - Balaji Natarajan
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, California
- Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
| | - Ramdas G. Pai
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, California
- Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
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Iribarne A, DiScipio AW, Leavitt BJ, Baribeau YR, McCullough JN, Weldner PW, Huang YL, Robich MP, Clough RA, Sardella GL, Olmstead EM, Malenka DJ. Comparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention in a real-world Surgical Treatment for Ischemic Heart Failure trial population. J Thorac Cardiovasc Surg 2018; 156:1410-1421.e2. [DOI: 10.1016/j.jtcvs.2018.04.121] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 02/06/2023]
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Ozdemir S, Kırılmaz B, Barutçu A, Tan YZ, Çelik F, Akgoz S. The evaluation of left ventricular dyssynchronization in patients with hypertension by phase analysis of myocardial perfusion-gated SPECT. Ann Nucl Med 2014; 29:240-7. [DOI: 10.1007/s12149-014-0933-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/19/2014] [Indexed: 12/01/2022]
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El-Menyar A, Shabana A, Arabi A, Al-Thani H, Asaad N, AlBinALi H, Singh R, Gomaa M, Gehani A. Congestive Heart Failure With Apparently Preserved Left Ventricular Systolic Function: A 10-Year Observational Study. Angiology 2014; 66:738-44. [PMID: 25248442 DOI: 10.1177/0003319714551198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analyzed the clinical presentation and outcomes (from 2003 to 2013) of heart failure (HF) with apparently normal systolic function (HFPEF). Based on the echocardiographic left ventricular ejection fraction (LVEF), patients were divided into 2 groups, group 1 (<50%) and group 2 (≥50%). Of 2212 patients with HF, 20% were in group 2. Patients in group 2 were more likely to be older, females, Arabs, hypertensive, and obese (P = .001). Patients in group 1 were mostly Asians and had more troponin-T positivity (P = .001). Inhospital cardiac arrest, shock, and deaths were significantly greater in group 1. On multivariate analysis, age, ST-segment elevation myocardial infarction, lack of on-admission β-blockers, and angiotensin-converting enzyme inhibitors use were independent predictors of mortality. HFPEF is associated with less mortality compared to those who presented with reduced LVEF. On admission, use of evidence-based medications could in part predict this difference in the hospital outcome.
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Affiliation(s)
- Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar Clinical Research, Trauma Section, Hamad Medical Corporation (HMC), Doha, Qatar Internal Medicine, Cardiology Section, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Adel Shabana
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdulrahman Arabi
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Hassan Al-Thani
- Vascular Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Nidal Asaad
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Hajar AlBinALi
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, HMC, Doha, Qatar
| | - Mohammed Gomaa
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - A Gehani
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
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