Pathology and pathobiology of pulmonary hypertension: state of the art and research perspectives

European Respiratory Journal, Год журнала: 2018, Номер 53(1), С. 1801887 - 1801887

Опубликована: Дек. 13, 2018

Clinical and translational research has played a major role in advancing our understanding of pulmonary hypertension (PH), including arterial other forms PH with severe vascular remodelling (e.g. chronic thromboembolic veno-occlusive disease). However, remains an incurable condition high mortality rate, underscoring the need for better transfer novel scientific knowledge into healthcare interventions. Herein, we review recent findings pathology (with questioning strict morphological categorisation various pre- or post-capillary involvement vessels) cellular mechanisms contributing to onset progression associated PH. We also discuss ways improve management support optimise drug development this field.

Язык: Английский

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Heart Failure With Preserved Ejection Fraction In Perspective

Circulation Research, Год журнала: 2019, Номер 124(11), С. 1598 - 1617

Опубликована: Май 23, 2019

Approximately half of the patients with signs and symptoms heart failure have a left ventricular ejection fraction that is not markedly abnormal. Despite historically initial surprise, heightened risks for specific major adverse events occur across broad range fraction, including normal. The recognition magnitude problem preserved in past 20 years has spurred an explosion clinical investigation growing intensity informative outcome trials. This article addresses historic development this component syndrome, epidemiology, pathophysiology, existing planned therapeutic studies. Looking forward, more phenotyping even genotyping subpopulations should lead to improvements outcomes from future

Язык: Английский

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Evaluation and management of heart failure with preserved ejection fraction

Nature Reviews Cardiology, Год журнала: 2020, Номер 17(9), С. 559 - 573

Опубликована: Март 30, 2020

Язык: Английский

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Pulmonary hypertension due to left heart disease

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.

Язык: Английский

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Pulmonary Arterial Hypertension

New England Journal of Medicine, Год журнала: 2021, Номер 385(25), С. 2361 - 2376

Опубликована: Дек. 15, 2021

Without effective treatment, pulmonary arterial hypertension results in high morbidity and mortality. This review discusses the pathogenesis of disorder, thorough clinical evaluation required to establish diagnosis, available therapies, future directions.

Язык: Английский

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Research Priorities for Heart Failure With Preserved Ejection Fraction

Circulation, Год журнала: 2020, Номер 141(12), С. 1001 - 1026

Опубликована: Март 23, 2020

Heart failure with preserved ejection fraction (HFpEF), a major public health problem that is rising in prevalence, associated high morbidity and mortality considered to be the greatest unmet need cardiovascular medicine today because of general lack effective treatments. To address this challenging syndrome, National Heart, Lung, Blood Institute convened working group made up experts HFpEF novel research methodologies discuss gaps prioritize directions over next decade. Here, we summarize discussion group, followed by key recommendations for future priorities. There was uniform recognition highly integrated, multiorgan, systemic disorder requiring multipronged investigative approach both humans animal models improve understanding mechanisms treatment HFpEF. It recognized advances basic roles inflammation, macrovascular microvascular dysfunction, fibrosis, tissue remodeling are needed ideally would obtained from (1) improved models, including large which incorporate effects aging comorbid conditions; (2) repositories deeply phenotyped physiological data human tissue, accessible researchers enhance collaboration advances; (3) methods take advantage computational multiscale modeling analysis complex, high-density across multiple domains. The emphasized interactions among basic, translational, clinical, epidemiological scientists organ systems cell types, leveraging different areas or focus, between centers. A network collaborative centers accelerate clinical pathobiological strategies discussed as an example strategy advance progress. This resource facilitate comprehensive, deep phenotyping multicenter patient cohort standardized protocols robust biorepository. priorities outlined document meant stimulate scientific providing road map investigations diverse

Язык: Английский

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Heart Failure With Preserved Ejection Fraction

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

Язык: Английский

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Heart failure with preserved ejection fraction: from mechanisms to therapies

European Heart Journal, Год журнала: 2018, Номер 39(30), С. 2780 - 2792

Опубликована: Май 8, 2018

This review aims to provide a translational perspective on recent developments in heart failure with preserved ejection fraction (HFpEF), linking mechanistic insights potential therapies. A key concept this is that HFpEF haemodynamic condition wherein the fails keep up circulatory demands of body, or does so at expense raised left ventricular filling pressures. We, therefore, propose 'final common pathway' for development congestion, i.e. basic mechanisms increased end-diastolic pressure, atrial hypertension, pulmonary venous and plasma volume expansion, represents important initial targets therapy HFpEF. Accordingly, we group into six translating therapies HFpEF: beginning three (left expansion), working backward molecular [systemic microvascular inflammation, cardiometabolic functional abnormalities, cellular (titin)/extracellular (fibrosis) structural abnormalities].

Язык: Английский

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Cellular and molecular pathobiology of heart failure with preserved ejection fraction

Nature Reviews Cardiology, Год журнала: 2021, Номер 18(6), С. 400 - 423

Опубликована: Янв. 11, 2021

Язык: Английский

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Heart Failure With Preserved Ejection Fraction

Journal of the American College of Cardiology, Год журнала: 2023, Номер 81(18), С. 1810 - 1834

Опубликована: Апрель 19, 2023

Язык: Английский

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