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Heart Failure With Preserved Ejection Fraction ― Time for a Paradigm Shift Beyond Diastolic Function ―

At present, heart failure with preserved ejection fraction (HFpEF) is a commonly accepted condition in HF patients. In contrast to HF with reduced EF (HFrEF), HFpEF is strongly associated with aging, and vascular, metabolic, neurohormonal, and systemic inflammatory comorbidities. Two major hypothese...

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Autores principales: Oki, Takashi, Miyoshi, Hirokazu, Oishi, Yoshifumi, Iuchi, Arata, Kusunose, Kenya, Yamada, Hirotsugu, Klein, Allan L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Circulation Society 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925123/
https://www.ncbi.nlm.nih.gov/pubmed/33693069
http://dx.doi.org/10.1253/circrep.CR-18-0017
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author Oki, Takashi
Miyoshi, Hirokazu
Oishi, Yoshifumi
Iuchi, Arata
Kusunose, Kenya
Yamada, Hirotsugu
Klein, Allan L.
author_facet Oki, Takashi
Miyoshi, Hirokazu
Oishi, Yoshifumi
Iuchi, Arata
Kusunose, Kenya
Yamada, Hirotsugu
Klein, Allan L.
author_sort Oki, Takashi
collection PubMed
description At present, heart failure with preserved ejection fraction (HFpEF) is a commonly accepted condition in HF patients. In contrast to HF with reduced EF (HFrEF), HFpEF is strongly associated with aging, and vascular, metabolic, neurohormonal, and systemic inflammatory comorbidities. Two major hypotheses explain the pathophysiology of HFpEF (stages C,D in the American College of Cardiology Foundation/American Heart Association HF staging system): (1) impaired active relaxation and increased passive stiffness of the left ventricular (LV) myocardium during diastole (left atrial [LA]-LV coupling); and (2) LV and arterial stiffening during systole (LV-arterial coupling). Cardiac structural and functional abnormalities can be evaluated using non-invasive measures, such as 2-D, flow velocity Doppler, and tissue Doppler echocardiography, to estimate LV filling pressure and afterload mismatch. The clinical application of 2-D speckle-tracking echocardiography (2D-STE) is feasible for earlier diagnosis of functional abnormalities of the LA, LV, and elastic arteries in asymptomatic patients with cardiovascular risk factors (stages A,B). The goal of this review is to highlight the role of 2D-STE to detect impairment of LA-LV-arterial coupling beyond diastolic function earlier, because it may provide important information on the pathophysiology and prevention of HFpEF.
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spelling pubmed-79251232021-03-09 Heart Failure With Preserved Ejection Fraction ― Time for a Paradigm Shift Beyond Diastolic Function ― Oki, Takashi Miyoshi, Hirokazu Oishi, Yoshifumi Iuchi, Arata Kusunose, Kenya Yamada, Hirotsugu Klein, Allan L. Circ Rep Review At present, heart failure with preserved ejection fraction (HFpEF) is a commonly accepted condition in HF patients. In contrast to HF with reduced EF (HFrEF), HFpEF is strongly associated with aging, and vascular, metabolic, neurohormonal, and systemic inflammatory comorbidities. Two major hypotheses explain the pathophysiology of HFpEF (stages C,D in the American College of Cardiology Foundation/American Heart Association HF staging system): (1) impaired active relaxation and increased passive stiffness of the left ventricular (LV) myocardium during diastole (left atrial [LA]-LV coupling); and (2) LV and arterial stiffening during systole (LV-arterial coupling). Cardiac structural and functional abnormalities can be evaluated using non-invasive measures, such as 2-D, flow velocity Doppler, and tissue Doppler echocardiography, to estimate LV filling pressure and afterload mismatch. The clinical application of 2-D speckle-tracking echocardiography (2D-STE) is feasible for earlier diagnosis of functional abnormalities of the LA, LV, and elastic arteries in asymptomatic patients with cardiovascular risk factors (stages A,B). The goal of this review is to highlight the role of 2D-STE to detect impairment of LA-LV-arterial coupling beyond diastolic function earlier, because it may provide important information on the pathophysiology and prevention of HFpEF. The Japanese Circulation Society 2018-12-14 /pmc/articles/PMC7925123/ /pubmed/33693069 http://dx.doi.org/10.1253/circrep.CR-18-0017 Text en Copyright © 2019, THE JAPANESE CIRCULATION SOCIETY This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Review
Oki, Takashi
Miyoshi, Hirokazu
Oishi, Yoshifumi
Iuchi, Arata
Kusunose, Kenya
Yamada, Hirotsugu
Klein, Allan L.
Heart Failure With Preserved Ejection Fraction ― Time for a Paradigm Shift Beyond Diastolic Function ―
title Heart Failure With Preserved Ejection Fraction ― Time for a Paradigm Shift Beyond Diastolic Function ―
title_full Heart Failure With Preserved Ejection Fraction ― Time for a Paradigm Shift Beyond Diastolic Function ―
title_fullStr Heart Failure With Preserved Ejection Fraction ― Time for a Paradigm Shift Beyond Diastolic Function ―
title_full_unstemmed Heart Failure With Preserved Ejection Fraction ― Time for a Paradigm Shift Beyond Diastolic Function ―
title_short Heart Failure With Preserved Ejection Fraction ― Time for a Paradigm Shift Beyond Diastolic Function ―
title_sort heart failure with preserved ejection fraction ― time for a paradigm shift beyond diastolic function ―
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925123/
https://www.ncbi.nlm.nih.gov/pubmed/33693069
http://dx.doi.org/10.1253/circrep.CR-18-0017
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