Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction
Abstract The findings of randomized trials of neurohormonal modulation have been neutral in heart failure with preserved ejection fraction and consistently positive in heart failure with reduced ejection. Left ventricular remodeling promotes the development and progression of heart failure with pres...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-06-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021120 |
| _version_ | 1819182705038852096 |
|---|---|
| author | Rohan Samson Thierry H. Le Jemtel |
| author_facet | Rohan Samson Thierry H. Le Jemtel |
| author_sort | Rohan Samson |
| collection | DOAJ |
| description | Abstract The findings of randomized trials of neurohormonal modulation have been neutral in heart failure with preserved ejection fraction and consistently positive in heart failure with reduced ejection. Left ventricular remodeling promotes the development and progression of heart failure with preserved and reduced ejection fraction. However, different stimuli mediate left ventricular remodeling that is commonly concentric in heart failure with preserved ejection fraction and eccentric in heart failure with reduced ejection. The stimuli that promote concentric left ventricular remodeling may account for the neutral findings of neuhormonal modulation in heart failure with preserved ejection fraction. Low‐grade systemic inflammation‐induced microvascular endothelial dysfunction is currently the leading hypothesis behind the development and progression of heart failure with preserved ejection fraction. The hypothesis provided the rationale for several randomized controlled trials that have led to neutral findings. The trials and their limitations are reviewed. |
| first_indexed | 2024-12-22T22:50:22Z |
| format | Article |
| id | doaj.art-288245c9a1e84a84bd2309bb0f64e36d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T22:50:22Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-288245c9a1e84a84bd2309bb0f64e36d2022-12-21T18:09:58ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-06-01101210.1161/JAHA.121.021120Therapeutic Stalemate in Heart Failure With Preserved Ejection FractionRohan Samson0Thierry H. Le Jemtel1Section of Cardiology John W. Deming Department of Medicine Tulane University School of Medicine New Orleans LASection of Cardiology John W. Deming Department of Medicine Tulane University School of Medicine New Orleans LAAbstract The findings of randomized trials of neurohormonal modulation have been neutral in heart failure with preserved ejection fraction and consistently positive in heart failure with reduced ejection. Left ventricular remodeling promotes the development and progression of heart failure with preserved and reduced ejection fraction. However, different stimuli mediate left ventricular remodeling that is commonly concentric in heart failure with preserved ejection fraction and eccentric in heart failure with reduced ejection. The stimuli that promote concentric left ventricular remodeling may account for the neutral findings of neuhormonal modulation in heart failure with preserved ejection fraction. Low‐grade systemic inflammation‐induced microvascular endothelial dysfunction is currently the leading hypothesis behind the development and progression of heart failure with preserved ejection fraction. The hypothesis provided the rationale for several randomized controlled trials that have led to neutral findings. The trials and their limitations are reviewed.https://www.ahajournals.org/doi/10.1161/JAHA.121.021120coronary microvascular dysfunctionHFpEFleft ventricular remodelingsystemic inflammation |
| spellingShingle | Rohan Samson Thierry H. Le Jemtel Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary microvascular dysfunction HFpEF left ventricular remodeling systemic inflammation |
| title | Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction |
| title_full | Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction |
| title_fullStr | Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction |
| title_full_unstemmed | Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction |
| title_short | Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction |
| title_sort | therapeutic stalemate in heart failure with preserved ejection fraction |
| topic | coronary microvascular dysfunction HFpEF left ventricular remodeling systemic inflammation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021120 |
| work_keys_str_mv | AT rohansamson therapeuticstalemateinheartfailurewithpreservedejectionfraction AT thierryhlejemtel therapeuticstalemateinheartfailurewithpreservedejectionfraction |