BOOK
Heart Failure with Preserved Ejection Fraction, An Issue of Heart Failure Clinics, E-Book
(2014)
Additional Information
Book Details
Abstract
This issue of Heart Failure Clinics examines Heart Failure with Preserved Ejection Fraction (HFPEF). The followings aspects of HFPEF are addressed: epidemiology, etiologic factors and pathophysiology, diagnosis, clinical spectrum, imaging, invasive hemodynamic characterization, exercise physiology, natriuretic peptides, novel biomarkers, differential diagnoses and comorbidities, outcomes, clinical trials, current therapeutic approach, and novel therapeutic targets.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Heart Failure with Preserved Ejection Fraction\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Heart Failure Clinics\r | xi | ||
| Foreword\r | xiii | ||
| Preface | xv | ||
| Epidemiology of Heart Failure with Preserved Ejection Fraction | 377 | ||
| Key points | 377 | ||
| Introduction | 377 | ||
| Risk Factors | 379 | ||
| Subclinical Disease Measures and Biomarkers Relating to HFPEF | 384 | ||
| Prevalence and incidence of HFPEF | 384 | ||
| Worldwide/Regional incidence and mortality | 384 | ||
| Clinical correlation | 385 | ||
| Summary | 385 | ||
| References | 386 | ||
| Causes and Pathophysiology of Heart Failure with Preserved Ejection Fraction | 389 | ||
| Key points | 389 | ||
| Introduction | 389 | ||
| HFPEF: a syndrome of deranged ventricular-arterial coupling | 390 | ||
| Interaction Between the Heart and Vasculature Is the Achilles Heel of the Cardiovascular System | 390 | ||
| Ventricular-Arterial Stiffening in HFPEF Resulting in Abnormal Ventricular-Arterial Coupling | 391 | ||
| Diastolic dysfunction in HFPEF | 391 | ||
| Systolic dysfunction in HFPEF | 392 | ||
| Chronotropic incompetence in HFPEF | 392 | ||
| Vascular stiffening in HFPEF | 392 | ||
| Risk factors and comorbidities as triggers in HFPEF | 392 | ||
| Cellular and molecular mechanisms of increased stiffness: translation of comorbidities to pathophysiology | 393 | ||
| Myofilament Determinants of Cellular Stiffness | 393 | ||
| Titin Versus Collagen | 394 | ||
| Coronary Microvascular Oxidative Stress | 395 | ||
| Disturbances in Ca2+-Related Relaxation | 395 | ||
| Summary | 395 | ||
| References | 396 | ||
| Diagnosis of Heart Failure with Preserved Ejection Fraction | 399 | ||
| Key points | 399 | ||
| Introduction | 399 | ||
| Nature of the Problem | 399 | ||
| Diagnosing HFpEF: What Do the Guidelines Say? | 399 | ||
| Symptom Criteria | 400 | ||
| Clinical findings | 400 | ||
| Physical Examination | 400 | ||
| Diagnostic Modalities | 401 | ||
| Differential diagnosis and diagnostic dilemmas | 401 | ||
| Process of Elimination | 402 | ||
| Comorbidities | 402 | ||
| Case studies | 402 | ||
| Patients Hospitalized for Heart Failure and HFpEF | 402 | ||
| Dyspnea on Exertion and HFpEF | 402 | ||
| Pulmonary Hypertension and Saline Infusion | 404 | ||
| Patients with HFpEF and Chronic Kidney Disease or Fluid Overload | 404 | ||
| Patients with HFpEF and Chronic Pulmonary Disease | 404 | ||
| Criteria for Heart Failure Diagnostics and Results of Clinical Trials | 404 | ||
| Summary | 405 | ||
| References | 405 | ||
| Phenotypic Spectrum of Heart Failure with Preserved Ejection Fraction | 407 | ||
| Key points | 407 | ||
| Introduction | 407 | ||
| Heterogeneity of HFpEF: epidemiologic studies versus pathophysiologic studies | 408 | ||
| Phenotypic classification of HFpEF | 409 | ||
| Pathophysiologic Classification of HFpEF | 410 | ||
| Clinical/Etiologic Classification of HFpEF | 410 | ||
| Classification of HFpEF Based on Clinical Presentation | 411 | ||
| Phenomics (Phenomapping) of HFpEF | 412 | ||
| The value of enhanced classification of HFpEF in future clinical trials | 415 | ||
| Summary | 416 | ||
| References | 417 | ||
| Imaging in Heart Failure with Preserved Ejection Fraction | 419 | ||
| Key points | 419 | ||
| Introduction | 419 | ||
| Planning cardiac imaging | 420 | ||
| Selection of Imaging Modality | 420 | ||
| Echo imaging technique | 421 | ||
| Interpretation/Assessment of clinical images | 422 | ||
| LVEF | 422 | ||
| Cardiac Structure | 422 | ||
| Diastolic Function | 423 | ||
| Myocardial Mechanics | 426 | ||
| RV Dysfunction and Pulmonary Hypertension | 429 | ||
| Vascular Imaging | 429 | ||
| Exercise/Stress Testing | 430 | ||
| Summary | 430 | ||
| References | 431 | ||
| Invasive Hemodynamic Characterization of Heart Failure with Preserved Ejection Fraction | 435 | ||
| Key points | 435 | ||
| Introduction | 435 | ||
| Load and Cardiac Function | 435 | ||
| Systolic Function | 436 | ||
| Diastolic Function | 436 | ||
| Ventricular-Arterial Interaction and Autonomic Influences | 437 | ||
| The hemodynamics of HFpEF | 438 | ||
| Diagnosis of HFpEF | 440 | ||
| Future directions | 442 | ||
| Summary | 442 | ||
| References | 442 | ||
| Exercise Physiology in Heart Failure and Preserved Ejection Fraction | 445 | ||
| Key points | 445 | ||
| Introduction | 445 | ||
| Heart Failure with Preserved Ejection Fraction: A Major Health Care Problem with No Proven Therapy | 445 | ||
| Exercise Intolerance is the Primary Symptom in Patients with HFPEF | 445 | ||
| Pathophysiology of Exercise Intolerance in Patients with HFPEF | 446 | ||
| Skeletal Muscle Mass and Oxygen Utilization and Exercise Intolerance in Patients with HFPEF | 446 | ||
| Impaired Muscle Blood Flow and Exercise Intolerance in Patients with HFPEF | 447 | ||
| Skeletal Muscle Composition, Fiber Type, and Capillarity and Exercise Intolerance in Patients with HFPEF | 448 | ||
| Therapeutic options and clinical outcomes | 448 | ||
| Effects of Physical Conditioning on Exercise Tolerance in Patients with HFPEF | 448 | ||
| Complications and concerns | 449 | ||
| Diagnostic Usefulness of Exercise Stress Testing in HFPEF | 449 | ||
| Safety of Supervised Exercise Training in Patients with HFPEF | 449 | ||
| Future directions | 449 | ||
| Summary | 450 | ||
| References | 450 | ||
| Natriuretic Peptides in Heart Failure with Preserved Ejection Fraction | 453 | ||
| Key points | 453 | ||
| Introduction | 453 | ||
| Natriuretic peptides and the diagnosis of ADHF in HFPEF | 454 | ||
| Cardiac structural and functional determinants of plasma NPs in HFPEF | 455 | ||
| NP concentrations in chronic HFPEF and HFREF | 456 | ||
| Early heart failure in the community | 457 | ||
| NPs in published guidelines for diagnosing HFPEF | 458 | ||
| NPs and prognosis in HFPEF | 458 | ||
| NPs and In-Hospital Mortality in ADHF with and Without Preserved LVEF | 459 | ||
| NPs and Prognosis in Chronic Stable HFPEF and HFREF | 461 | ||
| Are serial measurements of NPs useful for guiding therapy in HFPEF? | 464 | ||
| Insights into NPs in HFPEF from randomized controlled therapeutic trials | 465 | ||
| Summary | 467 | ||
| References | 468 | ||
| Novel Biomarkers in Heart Failure with Preserved Ejection Fraction | 471 | ||
| Key points | 471 | ||
| Background | 471 | ||
| Pathophysiology | 471 | ||
| Therapy | 472 | ||
| Biomarkers | 472 | ||
| Natriuretic Peptides | 472 | ||
| High-Sensitivity Troponin | 473 | ||
| Galectin-3 | 473 | ||
| Soluble ST2 | 474 | ||
| Renal Biomarkers | 475 | ||
| Future directions | 475 | ||
| References | 476 | ||
| Comorbidities and Differential Diagnosis in Heart Failure with Preserved Ejection Fraction | 481 | ||
| Key points | 481 | ||
| Introduction | 481 | ||
| Comorbidities | 481 | ||
| Cardiovascular comorbidities | 482 | ||
| Hypertension | 482 | ||
| Atrial Fibrillation | 488 | ||
| Coronary and Peripheral Artery Disease | 488 | ||
| Noncardiovascular comorbidity | 489 | ||
| Diabetes Mellitus | 489 | ||
| Obesity | 489 | ||
| Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension | 489 | ||
| Chronic Kidney Disease and Anemia | 490 | ||
| Other Comorbidities | 490 | ||
| Influence of Comorbidities on Development of HF-PEF | 490 | ||
| Influence of Comorbidities on Hospitalization and Death | 491 | ||
| Differential diagnosis | 491 | ||
| Cardiac Disease | 492 | ||
| Respiratory Disease | 492 | ||
| Other Diagnoses | 493 | ||
| Case 1 | 494 | ||
| Case 2 | 496 | ||
| Summary | 497 | ||
| References | 497 | ||
| Outcomes in Patients with Heart Failure with Preserved Ejection Fraction | 503 | ||
| Key points | 503 | ||
| Introduction | 503 | ||
| Role of EF in HF | 504 | ||
| Proportion of Patients with HF Who Have HF-PEF | 504 | ||
| Clinical outcomes | 504 | ||
| In-Hospital Mortality | 504 | ||
| Long-Term Mortality | 504 | ||
| Cause of death | 506 | ||
| Hospital admissions | 506 | ||
| Comorbidities in patients with HF-PEF | 507 | ||
| Therapeutic interventions for patients with HF-PEF | 507 | ||
| Inhibitors of the Renin-Angiotensin System | 507 | ||
| Summary | 508 | ||
| References | 508 | ||
| Clinical Trials in Patients with Heart Failure and Preserved Left Ventricular Ejection Fraction | 511 | ||
| Key points | 511 | ||
| Introduction | 511 | ||
| Diagnosis and classification of HFpEF | 512 | ||
| Hard outcomes versus soft surrogates | 513 | ||
| Randomized controlled trials | 513 | ||
| Angiotensin-converting Enzyme Inhibitors | 513 | ||
| Angiotensin Receptor Blockers | 513 | ||
| Dual Angiotensin Receptor Blocker-Neutral Endopeptidase Inhibitors | 516 | ||
| Mineralocorticoid Receptor Antagonists | 517 | ||
| β-Blockers | 517 | ||
| Calcium Channel Blockers | 517 | ||
| Digoxin | 518 | ||
| Ivabradine | 519 | ||
| Ranolazine | 519 | ||
| Sildenafil | 519 | ||
| Exercise Training | 519 | ||
| Devices | 519 | ||
| What did We Study and What Can We do to Improve Clinical Trials? | 519 | ||
| Summary | 520 | ||
| References | 520 | ||
| Current Therapeutic Approach in Heart Failure with Preserved Ejection Fraction | 525 | ||
| Key points | 525 | ||
| Background | 525 | ||
| Pharmacologic therapy | 525 | ||
| Renin-Angiotensin System Antagonists | 525 | ||
| Beta-Blockers | 527 | ||
| Aldosterone Receptor Blockade | 529 | ||
| Sildenafil | 529 | ||
| Neprilysin Inhibition | 531 | ||
| Statins | 531 | ||
| Nonpharmacological therapy | 531 | ||
| Low-Salt Diet | 531 | ||
| Exercise | 531 | ||
| Pacing | 532 | ||
| Baroreflex Activation Therapy | 533 | ||
| Contemporary therapeutic approach | 533 | ||
| Summary | 534 | ||
| References | 534 | ||
| Index | 539 |