Heart failure with preserved ejection fraction: New approaches to diagnosis and management
The majority of older patients who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). Patients with HFpEF have severe symptoms of exercise intolerance, poor quality‐of‐life, frequent hospitalizations, and increased mortality. The preval...
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| Veröffentlicht in: | Clinical cardiology (Mahwah, N.J.) Jg. 43; H. 2; S. 145 - 155 |
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| Abstract | The majority of older patients who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). Patients with HFpEF have severe symptoms of exercise intolerance, poor quality‐of‐life, frequent hospitalizations, and increased mortality. The prevalence of HFpEF is increasing and its prognosis is worsening. However, despite its importance, our understanding of the pathophysiology of HFpEF is incomplete, and drug development has proved immensely challenging. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. Originally viewed as a disorder due solely to abnormalities in left ventricular (LV) diastolic function, our understanding has evolved such that HFpEF is now understood as a systemic syndrome, involving multiple organ systems, likely triggered by inflammation and with an important contribution of aging, lifestyle factors, genetic predisposition, and multiple‐comorbidities, features that are typical of a geriatric syndrome. HFpEF is usually progressive due to complex mechanisms of systemic and cardiac adaptation that vary over time, particularly with aging. In this review, we examine evolving data regarding HFpEF that may help explain past challenges and provide future directions to care patients with this highly prevalent, heterogeneous clinical syndrome. |
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| AbstractList | The majority of older patients who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). Patients with HFpEF have severe symptoms of exercise intolerance, poor quality‐of‐life, frequent hospitalizations, and increased mortality. The prevalence of HFpEF is increasing and its prognosis is worsening. However, despite its importance, our understanding of the pathophysiology of HFpEF is incomplete, and drug development has proved immensely challenging. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. Originally viewed as a disorder due solely to abnormalities in left ventricular (LV) diastolic function, our understanding has evolved such that HFpEF is now understood as a systemic syndrome, involving multiple organ systems, likely triggered by inflammation and with an important contribution of aging, lifestyle factors, genetic predisposition, and multiple‐comorbidities, features that are typical of a geriatric syndrome. HFpEF is usually progressive due to complex mechanisms of systemic and cardiac adaptation that vary over time, particularly with aging. In this review, we examine evolving data regarding HFpEF that may help explain past challenges and provide future directions to care patients with this highly prevalent, heterogeneous clinical syndrome. The majority of older patients who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). Patients with HFpEF have severe symptoms of exercise intolerance, poor quality-of-life, frequent hospitalizations, and increased mortality. The prevalence of HFpEF is increasing and its prognosis is worsening. However, despite its importance, our understanding of the pathophysiology of HFpEF is incomplete, and drug development has proved immensely challenging. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. Originally viewed as a disorder due solely to abnormalities in left ventricular (LV) diastolic function, our understanding has evolved such that HFpEF is now understood as a systemic syndrome, involving multiple organ systems, likely triggered by inflammation and with an important contribution of aging, lifestyle factors, genetic predisposition, and multiple-comorbidities, features that are typical of a geriatric syndrome. HFpEF is usually progressive due to complex mechanisms of systemic and cardiac adaptation that vary over time, particularly with aging. In this review, we examine evolving data regarding HFpEF that may help explain past challenges and provide future directions to care patients with this highly prevalent, heterogeneous clinical syndrome.The majority of older patients who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). Patients with HFpEF have severe symptoms of exercise intolerance, poor quality-of-life, frequent hospitalizations, and increased mortality. The prevalence of HFpEF is increasing and its prognosis is worsening. However, despite its importance, our understanding of the pathophysiology of HFpEF is incomplete, and drug development has proved immensely challenging. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. Originally viewed as a disorder due solely to abnormalities in left ventricular (LV) diastolic function, our understanding has evolved such that HFpEF is now understood as a systemic syndrome, involving multiple organ systems, likely triggered by inflammation and with an important contribution of aging, lifestyle factors, genetic predisposition, and multiple-comorbidities, features that are typical of a geriatric syndrome. HFpEF is usually progressive due to complex mechanisms of systemic and cardiac adaptation that vary over time, particularly with aging. In this review, we examine evolving data regarding HFpEF that may help explain past challenges and provide future directions to care patients with this highly prevalent, heterogeneous clinical syndrome. |
| Author | Upadhya, Bharathi Kitzman, Dalane W. |
| AuthorAffiliation | 1 Cardiolovascular Medicine Section, Department of Internal Medicine Wake Forest School of Medicine Winston‐Salem North Carolina |
| AuthorAffiliation_xml | – name: 1 Cardiolovascular Medicine Section, Department of Internal Medicine Wake Forest School of Medicine Winston‐Salem North Carolina |
| Author_xml | – sequence: 1 givenname: Bharathi orcidid: 0000-0001-7192-7995 surname: Upadhya fullname: Upadhya, Bharathi email: bupadhya@wakehealth.edu organization: Wake Forest School of Medicine – sequence: 2 givenname: Dalane W. surname: Kitzman fullname: Kitzman, Dalane W. organization: Wake Forest School of Medicine |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31880340$$D View this record in MEDLINE/PubMed |
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| Copyright | 2019 The Authors. published by Wiley Periodicals, Inc. 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Keywords | preserved ejection fraction heart failure geriatric syndrome aging therapy |
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| Snippet | The majority of older patients who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). Patients... |
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| SubjectTerms | Age Factors Aged Aged, 80 and over Aging Biomarkers Cardiology Cell adhesion & migration Chronic obstructive pulmonary disease Clinical outcomes Clinical trials Comorbidity Drug development Ejection fraction Exercise Female geriatric syndrome Heart failure Heart Failure - diagnosis Heart Failure - epidemiology Heart Failure - physiopathology Heart Failure - therapy Humans Hypertension Inflammation Kinases Male Mortality Musculoskeletal system Obesity Older people Physical fitness Predictive Value of Tests preserved ejection fraction Quality of Life Recovery of Function Review Reviews Risk Assessment Risk Factors Stroke Volume therapy Time Factors Treatment Outcome Ultrasonic imaging Ventricular Function, Left |
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| Title | Heart failure with preserved ejection fraction: New approaches to diagnosis and management |
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