Page 10 - SHJ V5 No2 2018
P. 10

SHJ Vol 5, No 2, 2018                                           Elbur MA Prognosis in HFpEF                                 By: Dr.Mohamed El

                              HF symptoms with preserved LVEF + Primary

                          COMORBIDITIES                      DRUG USED
                          HYPERTENSION                       -ARB/ACEI
                                                             -Autonomic modulation
                          Fluid retention/Elevated filling   -ARNI
                          Diabetes, obesity, metabolic       -Glycemic control
                          syndrome, conditions associated    -Metformin(pleiotropic effects)
                          with oxidative stress              -Weight loss, bariatric surgery, diet
                                                             -PKG stimulation
                          Pulmonary hypertension or right    -PDES inhibitor
                          heart involvement                  -Orally active soluble guanylate
                                                             cyclase stimulator
                          Cardiac fibrosis                   -MRA
                          Ischemia                           -Na channel blockers

               Table 2:  Potential approach for matching key heart failure with preserved ejection fraction phenotypes to
               select therapeutic interventions. ARB, angiotensin receptor blocker; ACEI, angiotensin-converting enzyme
               inhibitor; MRA, mineralocorticoid receptor antagonist; ARNI, angiotensin receptor and neprilysin inhibitor;
               HF, heart failure; HTN, hypertension;  PKG, protein kinase G; AGE, advanced glycation end products; PDE,
               phosphodiesterase; MRA, mineralocorticoid receptor antagonist.[6]

               A  Mayo  Clinic  study  examined  all              predictor of future cardiovascular morbidity,
               consecutive  patients  hospitalized  with          but  prognosis  differs  from  that  in  patients
               decompensated  HF  from  1987  through             with symptoms of HFpEF. [7]
               2001.The  proportion  of  patients  with  the
               diagnosis of HFpEF increased over time and         Asymptomatic  diastolic  dysfunction —
               was  significantly higher among community           Diastolic  dysfunction  with  normal  systolic
               patients  than  among  referral  patients  (55     function  without  HF  (also  known  as  pre-
               versus  45  percent).  Over  the  next  decade     clinical  diastolic dysfunction) is  a common
               (2000 through 2010), the proportion of HF          finding  in  older  adults  and  a  predictor  of
               patients  with  HFpEF  continued  to  increase     mortality,  as  illustrated  by  the  following
               while  the  incidence  of  HFpEF  and  HFrEF       studies:
               declined. Diastolic function worsens as part       In   the   Mayo     Clinic   cross-sectional
               of  aging  even  in  individuals  without  other   community survey of 2042 adults ≥45 years
               forms      of    cardiovascular     disease,       of  age,  21  percent  had  mild  diastolic
               asymptomatic  diastolic  dysfunction  is  a        dysfunction,  7  percent  had  moderate

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