European Journal of Heart Failure,
Год журнала:
2022,
Номер
24(8), С. 1327 - 1345
Опубликована: Июль 1, 2022
Patients
with
heart
failure
preserved
ejection
fraction
(HFpEF)
universally
complain
of
exercise
intolerance
and
dyspnoea
as
key
clinical
correlates.
Cardiac
well
extracardiac
components
play
a
role
for
the
limited
capacity,
including
an
impaired
cardiac
peripheral
vascular
reserve,
limitation
in
mechanical
ventilation
and/or
gas
exchange
reduced
pulmonary
skeletal
muscle
dysfunction
iron
deficiency/anaemia.
Although
most
these
can
be
differentiated
quantified
through
analysis
by
cardiopulmonary
testing
(CPET),
information
provided
objective
measures
performance
has
not
been
systematically
considered
recent
algorithms/scores
HFpEF
diagnosis,
neither
European
nor
US
groups.
The
current
consensus
statement
Heart
Failure
Association
(HFA)
Preventive
Cardiology
(EAPC)
Society
(ESC)
aims
at
outlining
its
pathophysiological,
prognostic
insights,
addressing
implications
thorough
functional
evaluation
from
diagnostic
algorithm
to
pathophysiology
treatment
perspectives
HFpEF.
Along
goals,
we
provide
specific
evidence
that
CPET
is
standard
assessing,
quantifying,
differentiating
origin
impairment
even
more
so
when
combined
echocardiography
invasive
haemodynamic
evaluation.
This
will
lead
improved
quality
diagnosis
applying
proposed
scores
may
also
help
implement
progressive
characterization
phenotypes,
critical
step
toward
delivery
phenotype‐specific
treatments.
Circulation,
Год журнала:
2016,
Номер
135(9), С. 825 - 838
Опубликована: Дек. 31, 2016
Diagnosis
of
heart
failure
with
preserved
ejection
fraction
(HFpEF)
is
challenging
and
relies
largely
on
demonstration
elevated
cardiac
filling
pressures
(pulmonary
capillary
wedge
pressure).
Current
guidelines
recommend
use
natriuretic
peptides
(N-terminal
pro-B
type
peptide)
rest/exercise
echocardiography
(E/e'
ratio)
to
make
this
determination.
Data
support
practice
are
conflicting.Simultaneous
echocardiographic-catheterization
studies
were
prospectively
conducted
at
rest
during
exercise
in
subjects
invasively
proven
HFpEF
(n=50)
participants
dyspnea
but
no
identifiable
pathology
(n=24).N-Terminal
peptide
levels
below
the
level
considered
exclude
disease
(≤125
pg/mL)
18%
HFpEF.
E/e'
ratio
was
correlated
directly
measured
pulmonary
pressure
(r=0.63,
P<0.0001)
(r=0.57,
P<0.0001).
Although
specific,
current
poorly
sensitive,
identifying
only
34%
60%
basis
resting
echocardiographic
data
alone.
Addition
ratio>14)
improved
sensitivity
(to
90%)
thus
negative
predictive
value,
decreased
specificity
(71%).Currently
proposed
diagnostic
sensitive.
Adding
improves
value
compromises
specificity,
suggesting
that
may
help
rule
out
These
results
question
accuracy
approaches
alone
reinforce
testing
using
invasive
noninvasive
hemodynamic
assessments
definitively
confirm
or
refute
diagnosis
HFpEF.URL:
http://www.clinicaltrials.gov.
Unique
Identifier:
NCT01418248.
European Respiratory Journal,
Год журнала:
2018,
Номер
53(1), С. 1801897 - 1801897
Опубликована: Дек. 13, 2018
Pulmonary
hypertension
(PH)
is
frequent
in
left
heart
disease
(LHD),
as
a
consequence
of
the
underlying
condition.
Significant
advances
have
occurred
over
past
5
years
since
5th
World
Symposium
on
Hypertension
2013,
leading
to
better
understanding
PH-LHD,
challenges
and
gaps
evidence.
PH
failure
with
preserved
ejection
fraction
represents
most
complex
situation,
it
may
be
misdiagnosed
group
1
PH.
Based
latest
evidence,
we
propose
new
haemodynamic
definition
for
due
LHD
three-step
pragmatic
approach
differential
diagnosis.
This
includes
identification
specific
"left
heart"
phenotype
non-invasive
probability
PH-LHD.
Invasive
confirmation
PH-LHD
based
accurate
measurement
pulmonary
arterial
wedge
pressure
and,
patients
high
probability,
provocative
testing
clarify
Finally,
recent
clinical
trials
did
not
demonstrate
benefit
treating
hypertension-approved
therapies.
European Respiratory Journal,
Год журнала:
2018,
Номер
53(1), С. 1801900 - 1801900
Опубликована: Дек. 13, 2018
The
function
of
the
right
ventricle
determines
fate
patients
with
pulmonary
hypertension.
Since
heart
failure
is
consequence
increased
afterload,
a
full
physiological
description
cardiopulmonary
unit
consisting
both
and
vascular
system
required
to
interpret
clinical
data
correctly.
Here,
we
provide
such
its
components,
including
functional
interactions
between
load.
This
used
framework
for
interpretation
catheterisation
as
well
imaging
obtained
by
echocardiography
or
magnetic
resonance
imaging.
Finally,
an
update
provided
on
latest
insights
in
pathobiology
ventricular
failure,
key
pathways
molecular
adaptation
pressure
overloaded
ventricle.
Based
these
outcomes,
future
directions
research
are
proposed.
European Heart Journal - Cardiovascular Imaging,
Год журнала:
2016,
Номер
17(11), С. 1191 - 1229
Опубликована: Окт. 21, 2016
A
unique
and
highly
versatile
technique,
stress
echocardiography
(SE)
is
increasingly
recognized
for
its
utility
in
the
evaluation
of
non-ischaemic
heart
disease.
SE
allows
simultaneous
assessment
myocardial
function
haemodynamics
under
physiological
or
pharmacological
conditions.
Due
to
diagnostic
prognostic
value,
has
become
widely
implemented
assess
various
conditions
other
than
ischaemic
It
thus
essential
establish
guidance
applications
performance
area
This
paper
summarizes
these
recommendations.
European Heart Journal,
Год журнала:
2016,
Номер
37(43), С. 3293 - 3302
Опубликована: Июнь 26, 2016
Background
Exercise
intolerance
is
common
in
people
with
heart
failure
and
preserved
ejection
fraction
(HFpEF).
Right
ventricular
(RV)
dysfunction
has
been
shown
at
rest
HFpEF
but
little
data
are
available
regarding
dynamic
RV-pulmonary
artery
(PA)
coupling
during
exercise.
Methods
results
Subjects
(n
=
50)
controls
24)
prospectively
underwent
invasive
cardiopulmonary
exercise
testing
using
high-fidelity
micromanometer
catheters
along
simultaneous
assessment
of
RV
left
(LV)
mechanics
by
echocardiography.
Compared
rest,
subjects
displayed
systolic
diastolic
(RV
s′
e′),
impaired
LV
e′,
higher
biventricular
filling
pressures,
pulmonary
pressures.
On
exercise,
less
increase
stroke
volume,
rate,
cardiac
output
(CO),
blunted
CO
relative
to
O2
consumption
(VO2).
Enhancement
function
on
was
compared
controls.
Exercise-induced
PA
vasodilation
reduced
correlation
greater
venous
hypoxia.
Elevations
pressures
limitations
reserve
were
strongly
correlated
abnormal
enhancement
the
stress.
Conclusions
In
addition
limited
reserve,
patients
display
that
associated
high
inadequate
responses.
These
findings
highlight
importance
suggest
novel
therapies
targeting
myocardial
both
right
may
be
effective
improve
clinical
status.
