Review
Biochemistry & Molecular Biology
Jerremy Weerts, Sanne G. J. Mourmans, Arantxa Barandiaran Aizpurua, Blanche L. M. Schroen, Christian Knackstedt, Etto Eringa, Alfons J. H. M. Houben, Vanessa P. M. van Empel
Summary: Heart failure with preserved ejection fraction (HFpEF) is a disease with increasing incidence and no effective treatment. Coronary microvascular dysfunction plays a key role in the pathophysiology of HFpEF, possibly due to a low-grade pro-inflammatory state caused by systemic comorbidities. The presence or absence of peripheral microvascular dysfunction in HFpEF may reflect whether it is predominantly a cardiac or a systemic disease.
Article
Peripheral Vascular Disease
Michael A. Francisco, Joshua F. Lee, Zachary Barrett-O'Keefe, H. Jonathan Groot, Stephen M. Ratchford, Kanokwan Bunsawat, Jeremy K. Alpenglow, John J. Ryan, Jose N. Nativi, Russell S. Richardson, D. Walter Wray
Summary: The study revealed a significant decline in lower limb microvascular function in patients with HFpEF compared to healthy controls, possibly associated with systemic inflammation and oxidative damage. However, disease-related biomarkers of inflammation and oxidative damage were not correlated with responses to passive leg movement.
Review
Cardiac & Cardiovascular Systems
Aish Sinha, Haseeb Rahman, Andrew Webb, Ajay M. Shah, Divaka Perera
Summary: CMD, characterized by impaired coronary flow reserve (CFR), plays a central role in the pathogenesis of HFpEF, involving subendocardial ischemia and impaired lusitropy. Future prospective follow-up studies are essential for a better understanding of these diseases and may lead to the development of tailored therapies to improve quality of life and prognosis in patients with CMD and HFpEF.
EUROPEAN HEART JOURNAL
(2021)
Letter
Medicine, General & Internal
Elric Zweck, Ralf Westenfeld, Bjorn Redfors, Elmir Omerovic, Robin A. P. Weir, Domenico Gabrielli, Fabrizio Oliva, Giuseppe Zuccala, Scott D. Solomon, Muthiah Vaduganathan, John J. V. McMurray
Summary: Solomon et al. report on the DELIVER trial, which showed that dapagliflozin reduced risks of heart failure-related outcomes in patients with a mildly reduced or preserved left ventricular ejection fraction. These findings are expected to influence guidelines and clinical practice. The trial also confirmed dapagliflozin's efficacy in patients with a left ventricular ejection fraction of 60% or above.
NEW ENGLAND JOURNAL OF MEDICINE
(2023)
Letter
Medicine, General & Internal
Debdatta Bhattacharyya, Ayan Kar, Saurabh Dhumale, Filippos K. Triposkiadis, Andrew Xanthopoulos, Efstathios K. Iliodromitis, James Amato, Hiddo J. L. Heerspink, Lesley Inker, Tom Greene, Stefan D. Anker, Javed Butler, Milton Packer
Summary: In patients with heart failure and preserved ejection fraction, Empagliflozin reduced the incidence of primary outcome events compared to other drugs, but had higher rates of cardiovascular death, death from any cause, and hospitalization for heart failure compared to spironolactone.
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Sebastian Rosch, Karl-Patrik Kresoja, Christian Besler, Karl Fengler, Anne Rebecca Schoeber, Maximilian von Roeder, Christian Luecke, Matthias Gutberlet, Karin Klingel, Holger Thiele, Karl-Philipp Rommel, Philipp Lurz
Summary: In this study, patients with heart failure with preserved ejection fraction (HFpEF) were stratified based on left ventricular ejection fraction (LVEF), resulting in distinct morphologic and pathophysiologic subphenotypes. Patients with LVEF ranging from 50% to 60% demonstrated reduced contractility, impaired ventriculo-arterial coupling, and higher extracellular volume fraction, while patients with LVEF >60% exhibited a hypercontractile state with excessive left ventricular afterload and diminished preload reserve.
Article
Medicine, General & Internal
Monica Filice, Michele Golino, Marialessia Denora, Eleonora Ruscio, Gessica Ingrasciotta, Priscilla Lamendola, Laura Manfredonia, Angelo Villano, Antonio Bisignani, Salvatore E. Ravenna, Antonio De Vita, Oreste Lanza, Filippo Crea, Gaetano A. Lanza
Summary: This study found no relationship between the degree of impairment of coronary microvascular dilation and the presence of HFpEF in patients with MVA.
Article
Cardiac & Cardiovascular Systems
Barry A. Borlaug, Kavita Sharma, Sanjiv J. Shah, Jennifer E. Ho
Summary: The incidence and prevalence of heart failure with preserved ejection fraction (HFpEF) is increasing due to aging, obesity, sedentariness, and cardiometabolic disorders. Despite recent advances in understanding its pathophysiological effects and introduction of new diagnosis approaches, HFpEF remains under-recognized. This is concerning as effective treatments have been identified. This article provides an in-depth examination of the epidemiology, pathophysiology, diagnosis, and treatment of HFpEF. (J Am Coll Cardiol 2023;81:1810-1834) (c) 2023 by the American College of Cardiology Foundation.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Dan Tong, Gabriele G. Schiattarella, Nan Jiang, Francisco Altamirano, Pamela A. Szweda, Abdallah Elnwasany, Dong I. Lee, Heesoo Yoo, David A. Kass, Luke I. Szweda, Sergio Lavandero, Eric Verdin, Thomas G. Gillette, Joseph A. Hill
Summary: The study demonstrated through a mouse model that HFpEF is associated with myocardial mitochondrial dysfunction, and NAD(+) supplementation is considered a promising therapeutic approach.
CIRCULATION RESEARCH
(2021)
Article
Cardiac & Cardiovascular Systems
Ali Ahmad, Michel T. Corban, Takumi Toya, Frederik H. Verbrugge, Jaskanwal D. Sara, Lilach O. Lerman, Barry A. Borlaug, Amir Lerman
Summary: This study found that coronary microvascular function is inversely associated with filling pressures, particularly during exercise. Both types of coronary microvascular dysfunction are associated with higher filling pressures at peak exercise.
EUROPEAN JOURNAL OF HEART FAILURE
(2021)
Article
Radiology, Nuclear Medicine & Medical Imaging
Meng-Meng Yu, Wu-Xu Zuo, Xin Zhao, Xiang-Lin Tang, Yin-Yin Chen, Li-Li Dong, Xian-Hong Shu, Hang Jin, Meng-Su Zeng
Summary: This study investigated the prognostic value of coronary CT angiography (CCTA) in heart failure patients with preserved ejection fraction (HFpEF). The results showed a higher prevalence of coronary atherosclerosis in the HFpEF group compared to the non-HFpEF group. During the follow-up period, participants with HFpEF exhibited a higher risk of major adverse cardiovascular events (MACEs) in different CAD-RADS categories. CAD-RADS = 1-2 increased the risk of nonfatal myocardial infarction, while CAD-RADS ≥ 3 were associated with cardiovascular mortality and hospitalization due to heart failure.
EUROPEAN RADIOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Chanchal Chandramouli, Tay Wan Ting, Jasper Tromp, Anubha Agarwal, Sara Svedlund, Antti Saraste, Camilla Hage, Ru-San Tan, Lauren Beussink-Nelson, Maria Lagerstrom Fermer, Li-Ming Gan, Lars Lund, Sanjiv J. Shah, Carolyn S. P. Lam
Summary: Sex differences in coronary microvascular dysfunction (CMD) in heart failure with preserved ejection fraction (HFpEF) were investigated. The proteomic profiles associated with CMD differed between men and women with HFpEF. In men, CMD was associated with inflammation-mediated chemokine and cytokine signalling pathway, while in women, CMD was associated with pathways related to diabetes and other protein-related signalling.
EUROPEAN JOURNAL OF HEART FAILURE
(2022)
Article
Cardiac & Cardiovascular Systems
Thassio Mesquita, Rui Zhang, Jae Hyung Cho, Rui Zhang, Yen-Nien Lin, Lizbeth Sanchez, Joshua Goldhaber, Joseph K. Yu, Jialiu A. Liang, Weixin Liu, Natalia A. Trayanova, Eugenio Cingolani
Summary: Chronotropic incompetence and sinoatrial node (SAN) dysfunction are common problems in patients with heart failure, but the underlying mechanisms are not yet fully understood. This study identified intrinsic abnormalities in SAN structure and function as the cause of chronotropic incompetence in heart failure patients with preserved ejection fraction (HFpEF).
Article
Cardiac & Cardiovascular Systems
J. C. Weavil, T. S. Thurston, T. J. Hureau, J. R. Gifford, P. A. Kithas, R. M. Broxterman, A. D. Bledsoe, J. N. Nativi, R. S. Richardson, M. Amann
Summary: HFpEF patients show similar central and peripheral fatigue development as healthy controls during exercise not limited by cardiac output at the same relative intensity. However, HFpEF patients exhibit a greater susceptibility to neuromuscular fatigue during exercise at a given absolute intensity, which impairs functional capacity. The compromised leg blood flow response likely contributes to the attenuated fatigue resistance in HFpEF patients.
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY
(2021)
Article
Cardiac & Cardiovascular Systems
J. Ranjit Arnold, Prathap Kanagala, Charley A. Budgeon, Michael Jerosch-Herold, Gaurav S. Gulsin, Anvesha Singh, Jamal N. Khan, Daniel C. S. Chan, Iain B. Squire, Leong L. Ng, Gerry P. McCann
Summary: This study found that microvascular dysfunction (MVD) is highly prevalent in patients with heart failure with preserved ejection fraction (HFpEF) and is an independent predictor of prognosis. There is no significant linear correlation between MVD and fibrosis, challenging the assertion of a direct causal link between these entities.
JACC-CARDIOVASCULAR IMAGING
(2022)