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Reshaping Treatment of Heart Failure with Preserved Ejection Fraction

Current data indicate that in the community, approximately 50% of patients with heart failure (HF) have preserved left ventricular (LV) ejection fraction (LVEF)—the so-called HFpEF. Treatment of HFpEF has been considered an unmet need for decades. We believe that the main underlying reasons have bee...

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Autores principales: Karamichalakis, Nikolaos, Xanthopoulos, Andrew, Triposkiadis, Filippos, Paraskevaidis, Ioannis, Tsougos, Elias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267897/
https://www.ncbi.nlm.nih.gov/pubmed/35806994
http://dx.doi.org/10.3390/jcm11133706
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author Karamichalakis, Nikolaos
Xanthopoulos, Andrew
Triposkiadis, Filippos
Paraskevaidis, Ioannis
Tsougos, Elias
author_facet Karamichalakis, Nikolaos
Xanthopoulos, Andrew
Triposkiadis, Filippos
Paraskevaidis, Ioannis
Tsougos, Elias
author_sort Karamichalakis, Nikolaos
collection PubMed
description Current data indicate that in the community, approximately 50% of patients with heart failure (HF) have preserved left ventricular (LV) ejection fraction (LVEF)—the so-called HFpEF. Treatment of HFpEF has been considered an unmet need for decades. We believe that the main underlying reasons have been (a) the ever-changing LVEF cut-offs used for HF classification; (b) controversies regarding the definition of the LVEF normal range; (c) the fact that HFpEF does not represent a phenotype, but a category of diseases with entirely different characteristics (hypertensive heart disease, valvular heart disease (VHD), hypertrophic cardiomyopathy (HCM) etc.); (d) the lack of recognition that hypertensive HFpEF is the most common and important HFpEF phenotype; (e) the assumption that neurohormonal overactivity is absent in HF patients with a LVEF > 45–50% which has been proven to be wrong. Current HFpEF trials, in which the vast majority of the participants suffered from hypertension (HTN), whereas VHD and HCM were absent, demonstrated that neurohormonal and sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective in HF patients over a wide LVEF range. Thus, restricting these lifesaving treatments to HF patients with reduced LVEF is not justified anymore and it should be additionally considered for HFpEF patients suffering from HTN.
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spelling pubmed-92678972022-07-09 Reshaping Treatment of Heart Failure with Preserved Ejection Fraction Karamichalakis, Nikolaos Xanthopoulos, Andrew Triposkiadis, Filippos Paraskevaidis, Ioannis Tsougos, Elias J Clin Med Review Current data indicate that in the community, approximately 50% of patients with heart failure (HF) have preserved left ventricular (LV) ejection fraction (LVEF)—the so-called HFpEF. Treatment of HFpEF has been considered an unmet need for decades. We believe that the main underlying reasons have been (a) the ever-changing LVEF cut-offs used for HF classification; (b) controversies regarding the definition of the LVEF normal range; (c) the fact that HFpEF does not represent a phenotype, but a category of diseases with entirely different characteristics (hypertensive heart disease, valvular heart disease (VHD), hypertrophic cardiomyopathy (HCM) etc.); (d) the lack of recognition that hypertensive HFpEF is the most common and important HFpEF phenotype; (e) the assumption that neurohormonal overactivity is absent in HF patients with a LVEF > 45–50% which has been proven to be wrong. Current HFpEF trials, in which the vast majority of the participants suffered from hypertension (HTN), whereas VHD and HCM were absent, demonstrated that neurohormonal and sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective in HF patients over a wide LVEF range. Thus, restricting these lifesaving treatments to HF patients with reduced LVEF is not justified anymore and it should be additionally considered for HFpEF patients suffering from HTN. MDPI 2022-06-27 /pmc/articles/PMC9267897/ /pubmed/35806994 http://dx.doi.org/10.3390/jcm11133706 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Karamichalakis, Nikolaos
Xanthopoulos, Andrew
Triposkiadis, Filippos
Paraskevaidis, Ioannis
Tsougos, Elias
Reshaping Treatment of Heart Failure with Preserved Ejection Fraction
title Reshaping Treatment of Heart Failure with Preserved Ejection Fraction
title_full Reshaping Treatment of Heart Failure with Preserved Ejection Fraction
title_fullStr Reshaping Treatment of Heart Failure with Preserved Ejection Fraction
title_full_unstemmed Reshaping Treatment of Heart Failure with Preserved Ejection Fraction
title_short Reshaping Treatment of Heart Failure with Preserved Ejection Fraction
title_sort reshaping treatment of heart failure with preserved ejection fraction
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267897/
https://www.ncbi.nlm.nih.gov/pubmed/35806994
http://dx.doi.org/10.3390/jcm11133706
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