Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure
Approximately 50% of patients with heart failure have preserved ejection fraction. Although a wide variety of conditions cause or contribute to heart failure with preserved ejection fraction, elevated left ventricular filling pressures, particularly during exercise, are common to all causes. Acute e...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.016760 |
| _version_ | 1818775915160666112 |
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| author | Jan M. Griffin Barry A. Borlaug Jan Komtebedde Sheldon E. Litwin Sanjiv J. Shah David M. Kaye Elke Hoendermis Gerd Hasenfuß Finn Gustafsson Emil Wolsk Nir Uriel Daniel Burkhoff |
| author_facet | Jan M. Griffin Barry A. Borlaug Jan Komtebedde Sheldon E. Litwin Sanjiv J. Shah David M. Kaye Elke Hoendermis Gerd Hasenfuß Finn Gustafsson Emil Wolsk Nir Uriel Daniel Burkhoff |
| author_sort | Jan M. Griffin |
| collection | DOAJ |
| description | Approximately 50% of patients with heart failure have preserved ejection fraction. Although a wide variety of conditions cause or contribute to heart failure with preserved ejection fraction, elevated left ventricular filling pressures, particularly during exercise, are common to all causes. Acute elevation in left‐sided filling pressures promotes lung congestion and symptoms of dyspnea, while chronic elevations often lead to pulmonary vascular remodeling, right heart failure, and increased risk of mortality. Pharmacologic therapies, including neurohormonal modulation and drugs that modify the nitric oxide/cyclic GMP‐protein kinase G pathway have thus far been limited in reducing symptoms or improving outcomes in patients with heart failure with preserved ejection fraction. Hence, alternative means of reducing the detrimental rise in left‐sided heart pressures are being explored. One proposed method of achieving this is to create an interatrial shunt, thus unloading the left heart at rest and during exercise. Currently available studies have shown 3‐ to 5‐mm Hg decreases of pulmonary capillary wedge pressure during exercise despite increased workload. The mechanisms underlying the hemodynamic changes are just starting to be understood. In this review we summarize results of recent studies aimed at elucidating the potential mechanisms of improved hemodynamics during exercise tolerance following interatrial shunt implantation and the current interatrial shunt devices under investigation. |
| first_indexed | 2024-12-18T11:04:37Z |
| format | Article |
| id | doaj.art-27a811bf797249db91be68ea1278dbc6 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T11:04:37Z |
| publishDate | 2020-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-27a811bf797249db91be68ea1278dbc62022-12-21T21:10:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-09-0191710.1161/JAHA.120.016760Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart FailureJan M. Griffin0Barry A. Borlaug1Jan Komtebedde2Sheldon E. Litwin3Sanjiv J. Shah4David M. Kaye5Elke Hoendermis6Gerd Hasenfuß7Finn Gustafsson8Emil Wolsk9Nir Uriel10Daniel Burkhoff11New York Presbyterian Hospital New York NY USADepartment of Cardiovascular Medicine Mayo Clinic Rochester MN USACorvia Medical, Inc. Tewksbury MA USAMedical University of South Carolina, Charleston South Carolina. Ralph H. Johnson VA Medical Center Charleston SC USADivision of Cardiology Northwestern University Chicago IL USADepartment of Cardiology Alfred Hospital Melbourne AustraliaUniversity Medical Center Groningen the NetherlandsGeorg‐August Universität, Heart Centre Gottingen GermanyDepartment of Cardiology Rigshospitalet, Copenhagen DenmarkDepartment of Cardiology Rigshospitalet, Copenhagen DenmarkNew York Presbyterian Hospital New York NY USACardiovascular Research Foundation New York NY USAApproximately 50% of patients with heart failure have preserved ejection fraction. Although a wide variety of conditions cause or contribute to heart failure with preserved ejection fraction, elevated left ventricular filling pressures, particularly during exercise, are common to all causes. Acute elevation in left‐sided filling pressures promotes lung congestion and symptoms of dyspnea, while chronic elevations often lead to pulmonary vascular remodeling, right heart failure, and increased risk of mortality. Pharmacologic therapies, including neurohormonal modulation and drugs that modify the nitric oxide/cyclic GMP‐protein kinase G pathway have thus far been limited in reducing symptoms or improving outcomes in patients with heart failure with preserved ejection fraction. Hence, alternative means of reducing the detrimental rise in left‐sided heart pressures are being explored. One proposed method of achieving this is to create an interatrial shunt, thus unloading the left heart at rest and during exercise. Currently available studies have shown 3‐ to 5‐mm Hg decreases of pulmonary capillary wedge pressure during exercise despite increased workload. The mechanisms underlying the hemodynamic changes are just starting to be understood. In this review we summarize results of recent studies aimed at elucidating the potential mechanisms of improved hemodynamics during exercise tolerance following interatrial shunt implantation and the current interatrial shunt devices under investigation.https://www.ahajournals.org/doi/10.1161/JAHA.120.016760exerciseexercise capacityinteratrialshunt |
| spellingShingle | Jan M. Griffin Barry A. Borlaug Jan Komtebedde Sheldon E. Litwin Sanjiv J. Shah David M. Kaye Elke Hoendermis Gerd Hasenfuß Finn Gustafsson Emil Wolsk Nir Uriel Daniel Burkhoff Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease exercise exercise capacity interatrial shunt |
| title | Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure |
| title_full | Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure |
| title_fullStr | Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure |
| title_full_unstemmed | Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure |
| title_short | Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure |
| title_sort | impact of interatrial shunts on invasive hemodynamics and exercise tolerance in patients with heart failure |
| topic | exercise exercise capacity interatrial shunt |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.016760 |
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