Heart Failure Connect
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Heart Failure Characteristics and Treatment Plan by Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) represents approximately half of all heart failure cases. It is characterized by EF >50%, as well as different pro-inflammatory and metabolic co-morbidities. HFpEF entails structural and cellular alterations such as cardiomyocyte hypertrophy, fibrosis, and inflammation. These factors render the left ventricle unable to relax properly. The 5-year survival rate of HFpEF is 35%, which is worse than most cancers. Additionally, most treatments for HFrEF are ineffective for HFpEF.

The other 50% of heart failure cases comprise heart failure with reduced ejection fraction (HFrEF) and heart failure with mid-range or mildly reduced EF (HFmrEF).

HFrEF is characterized by EF ≤ 40% and involves severe cardiomyocyte loss, therefore resulting in the development of systolic dysfunction, or contractility problems of the left ventricle. Heart failure with mid-range or mildly reduced EF (HFmrEF) represents a liminal stage—categorized by an EF between 40% and 49%.

In 25% of cases, HFmrEF progresses to HFpEF, and in 33% of cases, it progresses to HFrEF. HFmrEF is more akin to HFrEF than HFpEF in terms of ischemic etiology. Nevertheless, HFmrEF exhibits a higher chance of underlying coronary artery disease (CAD) and improved overall prognosis.

Hypertension, T2DM, obesity, and renal insufficiency occur before HFpEF. On the other hand, HFrEF occurs after acute or chronic loss of cardiomyocytes due to ischemia, genetic mutation, myocarditis, or valvular disease.

What important clinical differences do you observe in HFrEF vs. HFpEF (vs. HFmrEF)? How does your assessment and plan differ in HFrEF vs. HFpEF (vs. HFmrEF)?

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  • 3yr
    ARNI ( or ace) , MRA , diuretic, SGLT inh, beta blocker for both types
  • 3yr
    I treat patients with HFmrEF similar to patients with HFrEF with beta-blockers, ARNi, spironolactone, diuretics, and SGLT2 inhibitors. I treat patients with HFpEF with diuretics, SGLT2 inhibitors, and blood Show More

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3yr
MINOCA and INOCA: Role in Heart Failure - Current Heart Failure Reports

MINOCA and INOCA: Role in Heart Failure - Current Heart Failure Reports

Source : https://link.springer.com/article/10.1007/s11897-023-00605-1

Purpose of Review Infarction (MINOCA) and ischaemia (INOCA) with non-obstructive coronary disease are recent non-conventional presentations of coronary syndromes that are increasingly recognised in the clinical arena, particularly with the...

Summary: MINOCA and INOCA are clearly related to HF. In both, there is a lack of studies on the identification of the risk factors for HF, diagnostic workup and, importantly, the appropriate primary and secondary prevention strategies.

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3yr
Cardiac contractility modulation: an effective treatment strategy for heart failure beyond reduced left ventricular ejection fraction? - Heart Failure Reviews

Cardiac contractility modulation: an effective treatment strategy for heart failure beyond reduced left ventricular ejection fraction? - Heart Failure Reviews

Source : https://link.springer.com/article/10.1007/s10741-023-10315-4

Heart failure (HF) with preserved ejection fraction (HFpEF) causes a progressive limitation of functional capacity, poor quality of life (QoL) and increased mortality, yet unlike HF with reduced ejection fraction...

Conclusions/Relevance: Available evidence on CCM in HFpEF is still preliminary, but improvements in terms of symptoms and QoL have been observed. Future large, dedicated, prospective studies are needed to evaluate the safety and efficacy of this therapy in patients with HFpEF.

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3yr
Utilization Rates of SGLT2 Inhibitors Among Patients With Type 2 Diabetes, Heart Failure, and Atherosclerotic Cardiovascular Disease: Insights From the Department of Veterans Affairs

Utilization Rates of SGLT2 Inhibitors Among Patients With Type 2 Diabetes, Heart Failure, and Atherosclerotic Cardiovascular Disease: Insights From the Department of Veterans Affairs

Source : https://www.sciencedirect.com/science/article/abs/pii/S2213177923001853?via=ihub

Available online 17 May 2023 Author links open overlay panel, b c , , , , a e , , , , , g h , , , , l...

Conclusions: Utilization rates of SGLT2 inhibitors are low in patients with ASCVD, HF, and T2DM, with high residual facility-level variation. These findings suggest opportunities to optimize SGLT2 inhibitor use to prevent future adverse cardiovascular events.

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3yr
Shockwave lithotripsy of calcific stenosis of the distal abdominal aorta to facilitate transcatheter aortic valve replacement

Shockwave lithotripsy of calcific stenosis of the distal abdominal aorta to facilitate transcatheter aortic valve replacement

Source : https://www.sciencedirect.com/science/article/abs/pii/S1553838923001616?via=ihub

The transfemoral approach for transcatheter aortic valve replacement (TAVR) is superior to alternative access strategies. Only transfemoral access has...

Relevance: We applied intravascular lithotripsy (IVL) to the distal abdominal aorta to achieve necessary luminal gain facilitating bioprosthetic aortic valve deployment.

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3yr
Efficacy of dapagliflozin in the treatment of HFrEF with obstructive sleep apnea syndrome (DAHOS study): study protocol for a multicentric, prospective, randomized controlled clinical trial - Trials

Efficacy of dapagliflozin in the treatment of HFrEF with obstructive sleep apnea syndrome (DAHOS study): study protocol for a multicentric, prospective, randomized controlled clinical trial - Trials

Source : https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-023-07332-x

Background Heart failure with reduced ejection fraction (HFrEF) is associated with sleep dyspnea (SDB), which plays an adverse role in the pathophysiology of the condition. SDB management in HFrEF, however,...

Conclusion: In summary, our RCT will provide data for analyses of the relationship between OSA and dapagliflozin, which may be a potential treatment for sleep apnea.

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3yr
Efficacy of Empagliflozin in Patients With Heart Failure Across Kidney Risk Categories

Efficacy of Empagliflozin in Patients With Heart Failure Across Kidney Risk Categories

Source : https://www.sciencedirect.com/science/article/pii/S0735109723050805?via=ihub

Empagliflozin reduces the risk of major heart failure outcomes in heart failure with reduced or preserved ejection fraction. The goal of this study was to evaluate the effect of empagliflozin...

Conclusions: The benefit of empagliflozin on major heart failure events was not influenced by KDIGO categories. The magnitude of the renal effects of the drug depended on the approach used to calculate eGFR slopes.

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3yr
Empagliflozin ameliorates diabetic cardiomyopathy via regulated branched-chain amino acid metabolism and mTOR/p-ULK1 signaling pathway-mediated autophagy - Diabetology & Metabolic Syndrome

Empagliflozin ameliorates diabetic cardiomyopathy via regulated branched-chain amino acid metabolism and mTOR/p-ULK1 signaling pathway-mediated autophagy - Diabetology & Metabolic Syndrome

Source : https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-023-01061-6

Background Empagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i), has been reported to significantly reduce the risk of heart failure in multiple clinical studies. However, the underlying mechanisms remain elusive. This...

Conclusions: Empagliflozin may attenuate diabetic cardiomyopathy-related myocardial injury by promoting the catabolism of BCAA and inhibiting mTOR/p-ULK1 to enhance autophagy. These findings suggest that empagliflozin could be a potential candidate drug against BCAA increase and could be used for other cardiovascular diseases with a metabolic...

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3yr

Skeletal Muscle Mitochondrial Respiration and Exercise Intolerance in Patients With Heart Failure With Preserved Ejection Fraction

Source : https://jamanetwork.com/journals/jamacardiology/fullarticle/2804714

Conclusions and Relevance: In this study, patients with HFpEF had marked abnormalities in skeletal muscle mitochondrial function. Severely reduced maximal capacity and complex I–linked and complex II–linked respiration were associated with exercise intolerance and represent promising therapeutic targets.

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3yr
Beta-Blocker Use and Heart Failure Outcomes in Mildly Reduced and Preserved Ejection Fraction

Beta-Blocker Use and Heart Failure Outcomes in Mildly Reduced and Preserved Ejection Fraction

Source : https://www.sciencedirect.com/science/article/abs/pii/S2213177923001737?via=ihub

The NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence) Registry is a quality improvement registry that began in 2008 and includes longitudinal data on >47 million visits...

Conclusions: In a large, real-world, propensity score-adjusted cohort of older outpatients with HF and EF ≥40%, beta-blocker use was associated with a higher risk of HF hospitalization as EF increased, with potential benefit in patients with HFmrEF and potential risk in patients with higher EF (particularly >60%). Further studies are...

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3yr
All-Cause and Cardiovascular-Related Mortality in CKD Patients With and Without Heart Failure: A Population-Based Cohort Study in Kaiser Permanente Southern California

All-Cause and Cardiovascular-Related Mortality in CKD Patients With and Without Heart Failure: A Population-Based Cohort Study in Kaiser Permanente Southern California

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10151415/

Albert S. Yu, 1 Katherine J. Pak, 2 Hui Zhou, 2, 3 Sally F. Shaw, 2 Jiaxiao Shi, 2 Benjamin I. Broder, 4 and John J.

Conclusions: Among patients with incident CKD, heart failure was highly prevalent with HFpEF accounting for over 70% among patients with known ejection fraction. Although the presence of heart failure was associated with higher 1-year all-cause and cardiovascular-related mortality, patients with HFrEF were the most vulnerable.

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3yr
How to Manage Heart Failure With Preserved Ejection Fraction: Practical Guidance for Clinicians

How to Manage Heart Failure With Preserved Ejection Fraction: Practical Guidance for Clinicians

Source : https://www.sciencedirect.com/science/article/abs/pii/S2213177923001427?via=ihub

Available online 3 May 2023 Author links open overlay panel Akshay S. Desai MD, MPH a , Carolyn S.P. Lam MBBS, PhD b c , John J.V. McMurray MD d...

Conclusions: A suggested algorithm for HFpEF treatment is outlined in the Central Illustration. Following confirmation of the diagnosis and exclusion of alternatives, treatment should focus on decongestion and optimal management of cardiac and noncardiac comorbidities.

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3yr
Redox-driven cardioprotective effects of sodium-glucose co-transporter-2 inhibitors: comparative review - Cardiovascular Diabetology

Redox-driven cardioprotective effects of sodium-glucose co-transporter-2 inhibitors: comparative review - Cardiovascular Diabetology

Source : https://cardiab.biomedcentral.com/articles/10.1186/s12933-023-01822-7

Sodium-glucose co-transporter-2 inhibitors are used in the treatment of diabetes but are also emerging as cardioprotective agents in heart diseases even in the absence of type 2 diabetes. In this...

Conclusion: Overall, both in vitro and in vivo studies agree in one thing: SGLT-2 inhibitors are able to protect our heart independent of their glucose lowering effects. However, more research is ahead of us before we are able to comprehensively decipher their direct and indirect cellular targets and corresponding mechanism of action, in...

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3yr
Relationship between Canagliflozin, Sodium Glucose Cotransporter 2 Inhibitor, and Hematopoietic Effects in Patients with Diabetes and Mild Heart Failure: Results from the CANDLE trial - PubMed

Relationship between Canagliflozin, Sodium Glucose Cotransporter 2 Inhibitor, and Hematopoietic Effects in Patients with Diabetes and Mild Heart Failure: Results from the CANDLE trial - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/37070931/

There were few clinical studies on the relationship between sodium glucose cotransporter 2 inhibitors (SGLT2i) and hematopoiesis in patients with diabetes (DM) and heart failure (HF) with consideration of systemic...

Conclusion: cCnagliflozin was associated with an increased hematocrit and hemoglobin in patients with diabetes and HF regardless of their volume status and characteristics.

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3yr
Cardio-renal-metabolic syndrome: clinical features and dapagliflozin eligibility in a real-world heart failure cohort - PubMed

Cardio-renal-metabolic syndrome: clinical features and dapagliflozin eligibility in a real-world heart failure cohort - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/37095712/

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Conclusions: This study identified high residual risk for all-cause mortality and hospital readmission in real-world HF patients with LVEF < 50% despite GDMT. T2D and CKD aggravated the risk for these endpoints, indicating the intertwinement of HF with CKD and T2D. SGLT2i treatment that clinically benefits these different disease...

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3yr
The effect of sodium-glucose cotransporter-2 inhibitors on cardiac structure remodeling and function: A meta-analysis of randomized controlled trials - PubMed

The effect of sodium-glucose cotransporter-2 inhibitors on cardiac structure remodeling and function: A meta-analysis of randomized controlled trials - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/37062643/

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Conclusion: Our study showed that SGLT2is, particularly empagliflozin, significantly reverse cardiac remodeling in patients with heart failure. Empagliflozin may be a potentially promising agent to reverse cardiac remodeling in clinical practice.

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3yr
Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure - Current Treatment Options in Cardiovascular Medicine

Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure - Current Treatment Options in Cardiovascular Medicine

Source : https://link.springer.com/article/10.1007/s11936-023-00979-4

Purpose of review To examine the emerging data for novel strategies being studied to improve use and dose titration of guideline-directed medical therapy (GDMT) for patients with heart failure (HF)....

Relevance: A large therapeutic gap between guideline-directed recommendations and real-world practice exists in the contemporary management of patients with HFrEF. Many strategies are being developed in an attempt to close this gap, as outlined in this review.

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3yr
Transcatheter Aortic Valve Replacement for Aortic Valve Infective Endocarditis: A Systematic Review and Call for Action - Cardiology and Therapy

Transcatheter Aortic Valve Replacement for Aortic Valve Infective Endocarditis: A Systematic Review and Call for Action - Cardiology and Therapy

Source : https://link.springer.com/article/10.1007/s40119-023-00314-9

We aimed to systematically analyze the literature on the use of transcatheter aortic valve replacement (TAVR) to treat active aortic valve infective endocarditis (AV-IE). Surgery is declined in one-third of...

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3yr
Effect of Dapagliflozin Versus Empagliflozin on Cardiovascular Death in Patients with Heart Failure Across the Spectrum of Ejection Fraction: Cost per Outcome Analysis - American Journal of Cardiovascular Drugs

Effect of Dapagliflozin Versus Empagliflozin on Cardiovascular Death in Patients with Heart Failure Across the Spectrum of Ejection Fraction: Cost per Outcome Analysis - American Journal of Cardiovascular Drugs

Source : https://link.springer.com/article/10.1007/s40256-023-00578-5

Background Dapagliflozin and empagliflozin have shown clinical benefits in patients with heart failure (HF). Their comparative monetary value remains undetermined, and we therefore sought to compare the cost-per-outcome implications of...

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3yr
Empagliflozin in heart failure with preserved ejection fraction with and without atrial fibrillation - PubMed

Empagliflozin in heart failure with preserved ejection fraction with and without atrial fibrillation - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/37062866/

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