Inotropes in Patients with Advanced Heart Failure
Patients with advanced heart failure suffer from severe and persistent symptoms, often not responding disease-modifying drugs, a marked limitation of functional capacity and poor quality of life that can ameliorate with inotropic drugs therapy. In small studies, pulsed infusions of classical inotropes (ie, dobutamine and milrinone) are associated with improvement in hemodynamic parameters and quality of life in patients with advanced heart failure. However, because of the adverse effects of these drugs, serious safety issues have been raised. Levosimendan is a calcium-sensitizing inodilators with a triple mechanism of acti...
Source: Heart Failure Clinics - July 21, 2021 Category: Cardiology Authors: Daniele Masarone, Enrico Melillo, Rita Gravino, Vittoria Errigo, Maria Luigia Martucci, Angelo Caiazzo, Andrea Petraio, Gerhard P ölzl, Giuseppe Pacileo Source Type: research
Left Ventricular Assist Device
Left ventricular assist devices (LVADs) are indicated in inotrope-dependent heart failure (HF) patients with pure or predominant LV dysfunction. Survival benefit is less clear in ambulatory, advanced HF. Timing is crucial: early, unnecessary exposure to the risks of surgery, and device-related complications (infections, stroke, and bleeding) should be weighed against the probability of dying or developing irreversible right ventricular and/or end-organ dysfunction while deferring implant. The interplay between LVAD and heart transplantation depends largely on donor availability and allocation rules. Postoperatively, qualit...
Source: Heart Failure Clinics - July 21, 2021 Category: Cardiology Authors: Maria Frigerio Source Type: research
Advanced Heart Failure in Special Population —Pediatric Age
Heart failure (HF) is an important health care issue in children because of its considerable morbidity and mortality. Advanced HF encompasses patients who remained symptomatic despite optimal medical treatment and includes patients who require special management, such as continuous inotropic therapy, mechanical circulatory support, or heart transplantation (HT). HT is the gold standard for children with advanced HF; nonetheless, the number of suitable donors has not increased for decades, leading to prolonged waitlist times and increased mortality rates. Therefore, the role of pediatric mechanic circulatory support has bee...
Source: Heart Failure Clinics - July 21, 2021 Category: Cardiology Authors: Emanuele Monda, Michele Lioncino, Roberta Pacileo, Marta Rubino, Annapaola Cirillo, Adelaide Fusco, Augusto Esposito, Federica Verrillo, Francesco Di Fraia, Alfredo Mauriello, Viviana Tessitore, Martina Caiazza, Arturo Cesaro, Paolo Calabr ò, Maria Giova Source Type: research
Advanced Heart Failure in a Special Population
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome that has become a global health issue, with mortality ranging from 53% to 74% at 5 years. It is defined as the presence of signs and symptoms of heart failure associated with left ventricular ejection fraction greater than or equal to 50%. The definition and diagnosis of HFpEF in patients with unexplained dyspnea remain a clinical challenge in the absence of a unique diagnostic algorithm universally recognized. Clinical trials conducted so far did not show a significant improvement of prognosis, but forthcoming therapies could provide i...
Source: Heart Failure Clinics - July 21, 2021 Category: Cardiology Authors: Simone Longhi, Giulia Saturi, Angelo Giuseppe Caponetti, Christian Gagliardi, Elena Biagini Source Type: research
Advanced Heart Failure
Advanced heart failure (HF) is characterized by a progressive worsening of symptoms disabling for daily life, refractory to all therapies, and with high mortality. These patients may be candidates for life-prolonging therapies, such as heart transplantation (HT) or long-term (LT) mechanical circulatory support (MCS) or must just require palliative therapies. The 1-year survival after HT and/or LT-MCS is approaching 80% to 90%, being patient selection and timely referral to advanced HF centers critical for optimal outcomes. There is no single symptom, sign, or test that can identify these patients and different classificati...
Source: Heart Failure Clinics - July 15, 2021 Category: Cardiology Authors: Maria Generosa Crespo-Leiro, Eduardo Barge-Caballero Source Type: research
Mitral and Tricuspid Valves Percutaneous Repair in Patients with Advanced Heart Failure
In heart failure with reduced ejection fraction, the interventional landscape has recently expanded. New transcatheter approaches are emerging for both mitral and tricuspid secondary (functional) regurgitation. Transcatheter therapies for mitral and tricuspid valve require a more tailored approach than for the aortic valve, because of more heterogeneous clinical scenarios, anatomic features, and mechanisms of valvular lesions. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - July 14, 2021 Category: Cardiology Authors: Valeria Cammalleri, Simona Mega, Gian Paolo Ussia, Francesco Grigioni Source Type: research
Pathophysiology of Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is a major public health problem that affects half of all patients with HF. It is rising in prevalence, is associated with high morbidity and mortality, and has very few effective treatments. HFpEF is currently understood as a heterogeneous syndrome originating from the interplay of cardiac and extracardiac abnormalities. The most important pathophysiology in patients with HFpEF is diastolic dysfunction, which presents with impairments in relaxation or increases in chamber stiffness that lead to an increase in left ventricular filling pressures at rest or during exerci...
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Jong-Chan Youn, Yuran Ahn, Hae Ok Jung Source Type: research
Hypertension and Heart Failure with Preserved Ejection Fraction
This article discusses the pathophysiological mechanisms linking hypertension with HFpEF and also the current evidence on the treatment of hypertension in patients with HFpEF. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Chan Joo Lee, Sungha Park Source Type: research
Obesity and Heart Failure with Preserved Ejection Fraction
Obese heart failure with preserved ejection fraction (HFpEF) is a distinct HFpEF phenotype. Sodium retention, high circulating neurohormone levels, alterations in energy substrate metabolism, group 3 pulmonary hypertension, pericardial restraint, and systemic inflammation are central pathophysiologic mechanisms. Confirming the diagnosis may be challenging and high suspicion is required. Reduction of visceral adipose tissue, via caloric restriction and/or bariatric surgery, may improve outcomes in obese HFpEF patients. Furthermore, mineralocorticoid receptor inhibition, neprilysin inhibition, and sodium-glucose cotransporte...
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Efstratios Koutroumpakis, Ramanjit Kaur, Heinrich Taegtmeyer, Anita Deswal Source Type: research
Sleep Disorder and Heart Failure with Preserved Ejection Fraction
It is generally considered that obstructive sleep apnea is a potential cause of heart failure (HF), and insomnia and central sleep apnea are results of HF. However, the number of reports describing the bidirectional relationship between sleep disorder and HF has increased. Sleep disorder may contribute to left ventricular diastolic dysfunction via left atrial overload, left ventricular remodeling, pulmonary hypertension, and atrial fibrillation, which lead to HF with preserved left ventricular ejection fraction. Overnight rostral fluid shift and lung congestion may lead to airflow obstruction in the upper pharynx and stimu...
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Masahiko Kato, Kazuhiro Yamamoto Source Type: research
Valvular Disease and Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome of shortness of breath and/or exercise intolerance secondary to elevated left ventricular filling pressures at rest or with exertion either as a result of primary diastolic dysfunction (primary HFpEF) or secondary to specific underlying causes (secondary HFpEF). In secondary HFpEF, early intervention of underlying valvular heart disease generally improves symptoms and prolongs survival. In primary HFpEF, there is increasing awareness of the existence and prognostic implications of secondary atrioventricular valve regurgitation. Further studies wi...
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Yiting Fan, Alex Pui-Wai Lee Source Type: research
Noninvasive Hemodynamic Evaluation at Rest in Heart Failure with Preserved Ejection Fraction
Noninvasive cardiac imaging by transthoracic echocardiography is among the first-line assessments in evaluation of heart failure patients with preserved ejection fraction (HFpEF). Although systolic function seems preserved by conventional measurers, important information is found through examination of the heart ’s hemodynamic profile through Doppler and novel echocardiographic measures. These measures aid in establishing the diagnosis of HFpEF and provide valuable prognostic information. Targets of interest include the left ventricle diastolic function, atrial structure and function, and right ventricula r function incl...
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Morten Sengel øv, Tor Biering-Sørensen Source Type: research
Stress Testing in Heart Failure with Preserved Ejection Fraction
Exertional dyspnea is the most common symptom in patients with heart failure with preserved ejection fraction; however, it is not specific to this disease. Stress testing provides crucial information about the diagnosis and prognosis of heart failure with preserved ejection before it reaches the advanced stage. Among various stress tests, noninvasive supine bicycle diastolic stress echocardiography has provided the most evidence for diagnosing and predicting the prognosis of heart failure with preserved ejection fraction. In current practice guidelines, a noninvasive or invasive diastolic stress test is recommended when a ...
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Chi Young Shim Source Type: research
Current Status of Pharmacologic and Nonpharmacologic Therapy in Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is a significantly symptomatic disease and has a poor prognosis similar to that of heart failure with reduced ejection fraction (HFrEF). Contrary to HFrEF, HFpEF is difficult to diagnose, and the recommended diagnostic algorithm of HFpEF is complicated. Several therapies for HFpEF have failed to reduce mortality or morbidity. HFpEF is thought to be a complex and heterogeneous systemic disorder that has various phenotypes and multiple comorbidities. Therefore, therapeutic strategies of HFpEF need to change depending on the phenotype of the patient. This review highlight...
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Mi-Na Kim, Seong-Mi Park Source Type: research
Clinical Phenogroups in Heart Failure with Preserved Ejection Fraction
This article describes currently recognized phenotypes of HFpEF and potential treatment strategies. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - May 27, 2021 Category: Cardiology Authors: Hidemi Sorimachi, Kazunori Omote, Barry A. Borlaug Source Type: research
