European Heart Journal,
Год журнала:
2022,
Номер
43(36), С. 3417 - 3431
Опубликована: Март 29, 2022
Abstract
Aims
Pulmonary
hypertension
(PH)
and
pulmonary
vascular
disease
(PVD)
are
common
associated
with
adverse
outcomes
in
left
heart
(LHD).
This
study
sought
to
characterize
the
pathophysiology
of
PVD
across
spectrum
PH
LHD.
Methods
results
Patients
PH-LHD
[mean
artery
(PA)
pressure
>20
mmHg
PA
wedge
(PAWP)
≥15
mmHg]
controls
free
or
LHD
underwent
invasive
haemodynamic
exercise
testing
simultaneous
echocardiography,
expired
air
blood
gas
analysis,
lung
ultrasound
a
prospective
study.
were
divided
into
isolated
post-capillary
(IpcPH)
[combined
post-
pre-capillary
(CpcPH)]
based
upon
resistance
(PVR
<3.0
≥3.0
WU).
As
compared
(n
=
69)
IpcPH-LHD
55),
participants
CpcPH-LHD
40)
displayed
poorer
atrial
function
more
severe
right
ventricular
(RV)
dysfunction
at
rest.
With
exercise,
patients
similar
PAWP
IpcPH-LHD,
but
RV–PA
uncoupling,
greater
interaction,
impairments
cardiac
output,
O2
delivery,
peak
consumption.
Despite
higher
PVR,
CpcPH
developed
congestion
both
controls,
which
was
lower
arterial
tension,
reduced
alveolar
ventilation,
decreased
diffusion,
ventilation-perfusion
mismatch.
Conclusions
is
distinct
pathophysiologic
signature
marked
by
exercise-induced
congestion,
hypoxaemia,
interdependence,
impairment
impairing
aerobic
capacity.
Further
required
identify
novel
treatments
targeting
vasculature
PH-LHD.
European Heart Journal,
Год журнала:
2019,
Номер
40(40), С. 3297 - 3317
Опубликована: Авг. 27, 2019
Abstract
Making
a
firm
diagnosis
of
chronic
heart
failure
with
preserved
ejection
fraction
(HFpEF)
remains
challenge.
We
recommend
new
stepwise
diagnostic
process,
the
‘HFA–PEFF
algorithm’.
Step
1
(P=Pre-test
assessment)
is
typically
performed
in
ambulatory
setting
and
includes
assessment
for
HF
symptoms
signs,
typical
clinical
demographics
(obesity,
hypertension,
diabetes
mellitus,
elderly,
atrial
fibrillation),
laboratory
tests,
electrocardiogram,
echocardiography.
In
absence
overt
non-cardiac
causes
breathlessness,
HFpEF
can
be
suspected
if
there
normal
left
ventricular
fraction,
no
significant
valve
disease
or
cardiac
ischaemia,
at
least
one
risk
factor.
Elevated
natriuretic
peptides
support,
but
levels
do
not
exclude
HFpEF.
The
second
step
(E:
Echocardiography
Natriuretic
Peptide
Score)
requires
comprehensive
echocardiography
by
cardiologist.
Measures
include
mitral
annular
early
diastolic
velocity
(e′),
(LV)
filling
pressure
estimated
using
E/e′,
volume
index,
LV
mass
relative
wall
thickness,
tricuspid
regurgitation
velocity,
global
longitudinal
systolic
strain,
serum
peptide
levels.
Major
(2
points)
Minor
(1
point)
criteria
were
defined
from
these
measures.
A
score
≥5
points
implies
definite
HFpEF;
≤1
point
makes
unlikely.
An
intermediate
(2–4
uncertainty,
which
case
3
(F1:
Functional
testing)
recommended
echocardiographic
invasive
haemodynamic
exercise
stress
tests.
4
(F2:
Final
aetiology)
to
establish
possible
specific
cause
alternative
explanations.
Further
research
needed
better
classification
Circulation,
Год журнала:
2018,
Номер
138(9), С. 861 - 870
Опубликована: Май 23, 2018
Diagnosis
of
heart
failure
with
preserved
ejection
fraction
(HFpEF)
is
challenging
in
euvolemic
patients
dyspnea,
and
no
evidence-based
criteria
are
available.
We
sought
to
develop
then
validate
noninvasive
diagnostic
that
could
be
used
estimate
the
likelihood
HFpEF
present
among
unexplained
dyspnea
guide
further
testing.
New England Journal of Medicine,
Год журнала:
2023,
Номер
389(12), С. 1069 - 1084
Опубликована: Авг. 25, 2023
BackgroundHeart
failure
with
preserved
ejection
fraction
is
increasing
in
prevalence
and
associated
a
high
symptom
burden
functional
impairment,
especially
persons
obesity.
No
therapies
have
been
approved
to
target
obesity-related
heart
fraction.MethodsWe
randomly
assigned
529
patients
who
had
body-mass
index
(the
weight
kilograms
divided
by
the
square
of
height
meters)
30
or
higher
receive
once-weekly
semaglutide
(2.4
mg)
placebo
for
52
weeks.
The
dual
primary
end
points
were
change
from
baseline
Kansas
City
Cardiomyopathy
Questionnaire
clinical
summary
score
(KCCQ-CSS;
scores
range
0
100,
indicating
fewer
symptoms
physical
limitations)
body
weight.
Confirmatory
secondary
included
6-minute
walk
distance;
hierarchical
composite
point
that
death,
events,
differences
KCCQ-CSS
C-reactive
protein
(CRP)
level.Download
PDF
Research
Summary.ResultsThe
mean
was
16.6
8.7
(estimated
difference,
7.8
points;
95%
confidence
interval
[CI],
4.8
10.9;
P<0.001),
percentage
−13.3%
−2.6%
−10.7
CI,
−11.9
−9.4;
P<0.001).
distance
21.5
m
1.2
20.3
m;
8.6
32.1;
In
analysis
point,
produced
more
wins
than
(win
ratio,
1.72;
1.37
2.15;
CRP
level
–43.5%
–7.3%
treatment
0.61;
0.51
0.72;
Serious
adverse
events
reported
35
participants
(13.3%)
group
71
(26.7%)
group.ConclusionsIn
obesity,
led
larger
reductions
limitations,
greater
improvements
exercise
function,
loss
placebo.
(Funded
Novo
Nordisk;
STEP-HFpEF
ClinicalTrials.gov
number,
NCT04788511.)
Quick
Take
Semaglutide
Heart
Failure
Obesity
2m
5s
JAMA,
Год журнала:
2023,
Номер
329(10), С. 827 - 827
Опубликована: Март 14, 2023
Heart
failure
with
preserved
ejection
fraction
(HFpEF),
defined
as
HF
an
EF
of
50%
or
higher
at
diagnosis,
affects
approximately
3
million
people
in
the
US
and
up
to
32
worldwide.
Patients
HFpEF
are
hospitalized
1.4
times
per
year
have
annual
mortality
rate
15%.Risk
factors
for
include
older
age,
hypertension,
diabetes,
dyslipidemia,
obesity.
Approximately
65%
patients
present
dyspnea
physical
examination,
chest
radiographic,
echocardiographic,
invasive
hemodynamic
evidence
overt
congestion
(volume
overload)
rest.
35%
"unexplained"
on
exertion,
meaning
they
do
not
clear
physical,
echocardiographic
signs
HF.
These
elevated
atrial
pressures
exercise
measured
stress
testing
estimated
Doppler
echocardiography
testing.
In
unselected
presenting
unexplained
dyspnea,
H2FPEF
score
incorporating
clinical
(age,
obesity,
fibrillation
status)
resting
(estimated
pulmonary
artery
systolic
pressure
left
pressure)
variables
can
assist
diagnosis
(H2FPEF
range,
0-9;
>5
indicates
more
than
95%
probability
HFpEF).
Specific
causes
syndrome
normal
other
should
be
identified
treated,
such
valvular,
infiltrative,
pericardial
disease.
First-line
pharmacologic
therapy
consists
sodium-glucose
cotransporter
type
2
inhibitors,
dapagliflozin
empagliflozin,
which
reduced
hospitalization
cardiovascular
death
by
20%
compared
placebo
randomized
trials.
Compared
usual
care,
training
diet-induced
weight
loss
produced
clinically
meaningful
increases
functional
capacity
quality
life
Diuretics
(typically
loop
diuretics,
furosemide
torsemide)
prescribed
improve
symptoms.
Education
self-care
(eg,
adherence
medications
dietary
restrictions,
monitoring
symptoms
vital
signs)
help
avoid
decompensation.Approximately
HFpEF.
exercise,
self-care,
diuretics
needed
maintain
euvolemia,
obesity