Page 9 - SHJ V5 No2 2018
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SHJ Vol 5, No 2, 2018                                           Elbur MA Prognosis in HFpEF                                 By: Dr.Mohamed El

                     Pathophysiological abnormalities.                     Clinical syndromes

               Ventricular Dysfunction:                       COPD
               -impaired relaxation
               - impaired filling
               -Systolic dysfunction

               Atrial Dysfunction                             Iron Deficiency Anemia
               Autonomic Dysfunction                          Renal dysfunction with fluid volume
               Chronotropic incompetence                      overload

               Vascular Dysfunction                           Aging and deconditioning
               Vascular stiffening
               Ventriculo-arterial coupling
               Elevated Blood                                 Obesity and Sarcopenia
               -inadquate BP response and Pulmonary
               Dynamic mitral valve regurgitation             Psychiatric disorders (depression)

                                                              Hypertension, Diabetes, ROS production

               Table (1) Heterogeneity of the heart failure with preserved ejection fraction syndrome. BP
               = blood pressure; COPD = chronic obstructive pulmonary disease.
               Matching  treatment  strategies  to  a  specific   was  reduced  with  beta-blocker  therapy
               patient’s phenotype in HFpEF is a promising        compared  with  placebo  (RR:  0.78,  95%CI
               approach  that  warrants  testing  in  clinical    0.65 to 0.94, p=0.008). There was no effect
               trials  and  may  increase  the  likelihood  of    seen  with  ACE  inhibitors,  aldosterone
               demonstrating  clinical  benefit  (Table  2).      receptor    blockers,     mineralocorticoid
               Targeting  specific  phenotypes  instead  of       receptor antagonists and other drug classes,
               following  the  ‘one-size-fits-all’  approach      compared with placebo. Similar results were
               becomes increasingly important in the light        observed  for  cardiovascular  mortality.  No
               of  several  failed,  non-targeted,  large-scale   single  drug  class  reduced  heart  failure
               HFpEF trials. [4]                                  hospitalization compared with placebo.[5]
               In  a  recent  review  of  25  RCTs  comprising
               data for 18101 patients. All-cause mortality

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