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Heart failure preserved

Candice Morrissey
Diastolic dysfunction ranging from impaired relaxation of the left ventricle to heart failure with preserved ejection fraction (HFpEF) is a common finding in the cardiac surgery population. It is important for the peri-operative echocardiographer to have a developed understanding of the pathophysiology of diastolic dysfunction and the echocardiographic features that determine where on the spectrum of diastolic function and dysfunction a patient lies.
October 2016: Annals of Cardiac Anaesthesia
Julia O Reynolds, Ann P Quick, Qiongling Wang, David L Beavers, Leonne E Philippen, Jordan Showell, Giselle Barreto-Torres, Donna J Thuerauf, Shirin Doroudgar, Christopher C Glembotski, Xander H T Wehrens
BACKGROUND: Junctophilin-2 (JPH2) is the primary structural protein for the coupling of transverse (T)-tubule associated cardiac L-type Ca channels and type-2 ryanodine receptors on the sarcoplasmic reticulum within junctional membrane complexes (JMCs) in cardiomyocytes. Effective signaling between these channels ensures adequate Ca-induced Ca release required for normal cardiac contractility. Disruption of JMC subcellular domains, a common feature of failing hearts, has been attributed to JPH2 downregulation...
October 8, 2016: International Journal of Cardiology
Rosita Zakeri, Gilles Moulay, Qiang Chai, Ozgur Ogut, Saad Hussain, Hiroyuki Takahama, Tong Lu, Xiao-Li Wang, Wolfgang A Linke, Hon-Chi Lee, Margaret M Redfield
BACKGROUND: Left atrial (LA) compliance and contractility influence left ventricular stroke volume. We hypothesized that diminished LA compliance and contractile function occur early during the development of heart failure with preserved ejection fraction (HFpEF) and impair overall cardiac performance. METHODS AND RESULTS: Cardiac magnetic resonance imaging, echocardiography, left ventricular and LA pressure-volume studies, and tissue analyses were performed in a model of early HFpEF (elderly dogs, renal wrap-induced hypertension, exogenous aldosterone; n=9) and young control dogs (sham surgery; n=13)...
October 2016: Circulation. Heart Failure
Catarina Francisco, João Sérgio Neves, Inês Falcão-Pires, Adelino Leite-Moreira
Adiponectin is the most abundant adipokine and exhibits anti-inflammatory, antiatherogenic and antidiabetic properties. Unlike other adipokines, it inversely correlates with body weight and obesity-linked cardiovascular complications. Diastolic dysfunction is the main mechanism responsible for approximately half of all heart failure cases, the so-called heart failure with preserved ejection fraction (HFpEF), but therapeutic strategies specifically directed towards these patients are still lacking. In the last years, a link between adiponectin and diastolic dysfunction has been suggested...
October 18, 2016: Cardiovascular Drugs and Therapy
Javed Butler, Carine E Hamo, James E Udelson, Bertram Pitt, Clyde Yancy, Sanjiv J Shah, Patrice Desvigne-Nickens, Harold S Bernstein, Richard L Clark, Christophe Depre, Wilfried Dinh, Andrew Hamer, Patricia Kay-Mugford, Frank Kramer, Martin Lefkowitz, Kelly Lewis, Juan Maya, Simon Maybaum, Mahesh J Patel, Pia S Pollack, Lothar Roessig, Sarit Rotman, Afshin Salsali, J Jason Sims, Michele Senni, Giuseppe Rosano, Preston Dunnmon, Norman Stockbridge, Stefan D Anker, Michael R Zile, Mihai Gheorghiade
The epidemiological, clinical, and societal implications of the heart failure (HF) epidemic cannot be overemphasized. Approximately half of all HF patients have HF with preserved ejection fraction (HFpEF). HFpEF is largely a syndrome of the elderly, and with aging of the population, the proportion of patients with HFpEF is expected to grow. Currently, there is no drug known to improve mortality or hospitalization risk for these patients. Besides mortality and hospitalization, it is imperative to realize that patients with HFpEF have significant impairment in their functional capacity and their quality of life on a daily basis, underscoring the need for these parameters to ideally be incorporated within a regulatory pathway for drug approval...
November 2016: Circulation. Heart Failure
Zhanna Kobalava
The burden of cardiovascular diseases (CVD) in general and heart failure (HF) in particular continues to increase worldwide. CVD are major contributors to death and morbidity and recognized as important drivers of healthcare expenditure. Chronic overactivity of the renin-angiotensin-aldosterone system (RAAS) plays a key role in human hypertension and HF pathophysiology. RAAS is fundamental in the overall regulation of cardiovascular homeostasis through the actions of hormones, which regulate vascular tone, and specifically blood pressure through vasoconstriction and renal sodium and water retention...
September 2016: Journal of Hypertension
Stephen Robert Daniels
Hypertension in children and adolescents is associated with both short and long-term abnormalities in the cardiovascular system. Ultimately, these changes can lead to myocardial infarction, stroke, congestive heart failure and chronic renal disease, all of which are associated with substantial morbidity and mortality.In the short term, the best evidence that hypertension is adversely impacting the heart and vasculature is the development of left ventricular hypertrophy, increased vascular stiffness and endothelial dysfunction...
September 2016: Journal of Hypertension
William C Cushman
Beginning with the Veterans Administration (VA) Cooperative Hypertension Study of the 1960 s, blood pressure (BP) lowering with antihypertensive medications has been shown to reduce major cardiovascular (CV) outcomes, including coronary heart disease, stroke, heart failure (HF) and CV and all-cause mortality in randomized controlled CV outcome trials. Multiple drugs were usually required in these trials to lower BP in treated participants. Medication regimens in the early trials, including the VA trial, included a thiazide-type diuretic (TTD) as initial therapy...
September 2016: Journal of Hypertension
Enrico Agabiti Rosei
Current Hypertension Guidelines emphasize the importance of assessing the presence of preclinical organ damage. In fact, an extensive evaluation of organ damage may increase the number of patients classified at high CV risk and therefore strongly influence the clinical management of patients. Hypertensive heart disease remains to date the form of organ damage for which there is the greatest amount of evidence of a strong independent prognostic significance. In the presence of a chronic pressure overload, a parallel addition of sarcomers takes place with an increase in myocyte width, which in turn increases left ventricular wall thickness; myocyte hypertrophy is also associated with apoptosis, collagen deposition and ventricular fibrosis with an impairment of coronary hemodynamics as well, thus profoundly influencing functional properties of the left (and right) ventricle...
September 2016: Journal of Hypertension
Chong-Jin Kim
With several lines of evidence, angiotensin-converting enzyme (ACE) inhibitors are recommended in patients with left ventricular systolic dysfunction or heart failure after myocardial infarction, and angiotensin receptor blockers (ARBs) are indicated in patients who are intolerant of ACE inhibitors. Up to 20% of patients cannot tolerate ACE inhibitors due to adverse reactions such as cough or angioedema, ARBs could be an alternative to ACE inhibitors. However, there is lack of data whether ARBs are comparable to ACE inhibitors in patients with myocardial infarction...
September 2016: Journal of Hypertension
Blazej Michalski, Przemyslaw Trzcinski, Karolina Kupczynska, Dawid Miskowiec, Lukasz Peczek, Barbara Nawrot, Piotr Lipiec, Jaroslaw D Kasprzak
BACKGROUND: The aim of the study was to assess the correlation of the selected biomarkers and collagen turn-over indices with advanced echocardiographic parameters among patients with preserved and reduced ejection fraction (EF). METHODS: We included 62 patients with the symptomatic heart failure. The patients were divided in to two groups according to the evaluated ejection fraction (EF - Simpson method): heart failure with reduced ejection fraction (HFrEF) group - 30 patients with low EF - 35-50% (16 male, mean age 54...
October 17, 2016: Cardiology Journal
Erick Chan, Francesco Giallauria, Carlo Vigorito, Neil A Smart
Exercise training induces physical adaptations for heart failure patients with systolic dysfunction but less is known about those patients with preserved ejection fraction. This study's aims were to establish if exercise training produces changes in peak VO2 and related measures, quality of life, general health and diastolic function in heart failure patients with preserved ejection fraction (HFpEF). We conducted a MEDLINE search (1985 to September 1, 2015), for exercise based rehabilitation trials in heart failure, using search terms 'exercise training, heart failure with preserved ejection fraction, heart failure with  normal ejection fraction, peak VO2 and diastolic heart dysfunction'...
October 14, 2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Michael R Bristow, Jorge Silva Enciso, Bernard J Gersh, Christine Grady, Madeline Murguia Rice, Steven Singh, George Sopko, Robin Boineau, Yves Rosenberg, Barry H Greenberg
TOPCAT was a multinational clinical trial of 3,445 heart failure with preserved ejection fraction (HFpEF) patients that enrolled in 233 sites in six countries in North America, Eastern Europe and South America. Patients with a heart failure hospitalization in the last 12 months or an elevated B-type natriuretic peptide (BNP) were randomized to the mineralocorticoid receptor antagonist spironolactone vs. placebo. Sites in Russia and the Republic of Georgia provided the majority of early enrollment, primarily based on the hospitalization criterion since BNP levels were initially unavailable there...
April 2016: JACC. Basic to Translational Science
Satoshi Masutani, Seiko Kuwata, Clara Kurishima, Yoichi Iwamoto, Hirofumi Saiki, Masaya Sugimoto, Hirotaka Ishido, Hideaki Senzaki
OBJECTIVE: The details of the ventricular-vascular dynamics of heart failure with preserved ejection fraction (HFpEF) in children remain poorly understood. We tested the hypothesis that pediatric HFpEF patients have ventricular systolic, diastolic, and arterial stiffening at rest as well as impaired reserve function associated with coronary supply/demand imbalance. METHODS: We studied the ventricular pressure-area relationship in 22 pediatric HFpEF patients and 22 control subjects before and after dobutamine infusion and during abdominal compression...
September 30, 2016: International Journal of Cardiology
Parul U Gandhi, Hanna K Gaggin, Margaret M Redfield, Horng H Chen, Susanna R Stevens, Kevin J Anstrom, Marc J Semigran, Peter Liu, James L Januzzi
OBJECTIVES: This study sought to investigate relationships between insulin-like growth factor-binding protein 7 (IGFBP7) and parameters of diastolic function or functional capacity in patients with heart failure and preserved ejection fraction (HFpEF) who were randomized to receive sildenafil or placebo. BACKGROUND: IGFBP7 was previously found to be associated with diastolic function in heart failure with reduced ejection fraction, but it is unclear whether these associations are present in HFpEF...
September 29, 2016: JACC. Heart Failure
Julio A Chirinos, Scott R Akers, Lien Trieu, Harry Ischiropoulos, Paschalis-Thomas Doulias, Ali Tariq, Izzah Vassim, Maheswara R Koppula, Amer Ahmed Syed, Haideliza Soto-Calderon, Raymond R Townsend, Thomas P Cappola, Kenneth B Margulies, Payman Zamani
BACKGROUND: Stable plasma nitric oxide (NO) metabolites (NOM), composed predominantly of nitrate and nitrite, are attractive biomarkers of NO bioavailability. NOM levels integrate the influence of NO-synthase-derived NO production/metabolism, dietary intake of inorganic nitrate/nitrite, and clearance of NOM. Furthermore, nitrate and nitrite, the most abundant NOM, can be reduced to NO via the nitrate-nitrite-NO pathway. METHODS AND RESULTS: We compared serum NOM among subjects without heart failure (n=126), subjects with heart failure and preserved ejection fraction (HFpEF; n=43), and subjects with heart failure and reduced ejection fraction (HFrEF; n=32)...
October 14, 2016: Journal of the American Heart Association
Emmanuelle Berthelot, David Montani, Vincent Algalarrondo, Céline Dreyfus, Raed Rifai, Anouar Benmalek, Xavier Jais, Amir Bouchachi, Laurent Savale, Gerald Simonneau, Denis Chemla, Marc Humbert, Olivier Sitbon, Patrick Assayag
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a frequent cause of pulmonary hypertension (PH) that is not easy to differentiate from precapillary PH. We aimed to determine whether the characteristic features of the patients may help differentiate between HFpEF and precapillary-PH. METHODS AND RESULTS: Clinical and echocardiographic parameters were analyzed in 156 patients referred to our PH referral center. Right heart catheterization identified 78 PH-HFpEF patients and 78 precapillary-PH...
October 11, 2016: Journal of Cardiac Failure
Nisha A Gilotra, Adam Shpigel, Ike S Okwuosa, Ruth Tamrat, Deirdre Flowers, Stuart D Russell
BACKGROUND: There is a paucity of data describing patient-identified precipitants of heart failure (HF) hospitalization. We hypothesized a patient's perception of reason for or preventability of an admission may be related to 30-day readmission rates. METHODS AND RESULTS: Ninety-four patients admitted with decompensated HF from July 2014 to March 2015 completed a brief questionnaire regarding circumstances leading to admission. Thirty-day outcomes were assessed via telephone call and chart review...
October 11, 2016: Journal of Cardiac Failure
Payman Zamani, Benjamin French, Jeffrey A Brandimarto, Paschalis-Thomas Doulias, Ali Javaheri, Julio A Chirinos, Kenneth B Margulies, Raymond R Townsend, Nancy K Sweitzer, James C Fang, Harry Ischiropoulos, Thomas P Cappola
Endothelial function may be deranged in heart failure with preserved ejection fraction (HFpEF). Serum NO-derived metabolites (NOm) might provide a biochemical surrogate of endothelial function in patients with heart failure (HF). We measured serum NOm in 415 participants in the Penn HF Study. Participants with HFpEF (n = 82) and those whose EF had recovered (Recovered-HF, n = 125) were matched 1:1 to heart failure with reduced ejection fraction (HFrEF) participants based on age, gender, race, tobacco use, and eGFR...
September 15, 2016: American Journal of Cardiology
Masaru Obokata, Yasufumi Nagata, Yuichiro Kado, Masahiko Kurabayashi, Yutaka Otsuji, Masaaki Takeuchi
BACKGROUND: Exercise-induced pulmonary hypertension (EIPH) may develop even at low workloads in heart failure (HF) patients. Ventricular-arterial stiffening plays an important role in the pathophysiology of HF with preserved ejection fraction (HFpEF). This study aimed to compare the response of ventricular-arterial coupling and PH during low-level exercise between HFpEF and HF with reduced EF (HFrEF). METHODS AND RESULTS: Echocardiography was performed at rest and during 10 W of bicycle exercise in HFpEF (n=37) and HFrEF (n=43)...
October 10, 2016: Journal of Cardiac Failure
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