Is heart failure with preserved ejection fraction a serious illness?

Czech version

Authors: J. Murín ¹; M. Macháčová ²; R. Compagnon ³; J. Bulas ¹; M. Wawruch ⁴
Authors‘ workplace: I. interná klinika LF UK a UN Bratislava ¹; Praktický lekár pre dospelých, MIMAD s. r. o., Topoľčany ²; Praktický lekár pre dospelých, MEDIROM s. r. o, Bratislava ³; Ústav klinickej farmakologie LF UK a UN Bratislava ⁴
Published in: Kardiol Rev Int Med 2017, 19(3): 168-171

Overview

Heart failure today has a high prevalence and incidence. In clinical practice, we recognize two basic forms of this disease. We have little data on the causes, the pathogenesis and the way of death, especially in patients with heart failure with the left ventricle's "preserved ejection fraction". It is time to indulge this disease so that we can affect its pathogenesis, but especially morbidity and mortality. We do not know today whether the mechanisms of sudden death or fatal heart pump failure are similar to those of systolic heart failure or are different. Some clinical experience has shown that mortality in "preserved ejection fraction" heart failure as a "cardiac pump" failure is different from systolic heart failure and passes through progressive pulmonary hypertension, right ventricular failure, renal venous congestion, and subsequent renal function failure, and subsequently later via multi-organ dysfunction – failure. We present literature data from randomized clinical trials and epidemiological studies: most heart failure patients with "preserved ejection fraction" die from cardiovascular causes. However, specific causes of cardiovascular death are poorly defined in the studies. Sudden death accounts for about 30– 40% of deaths, and there are frequent non-cardiovascular deaths (about 20– 30%). The acquisition of these data is necessary in order to favorably influence the prognosis of these severely ill patients.

Keywords:
heart failure with preserved ejection fraction – mortality – clinical studies

Sources

1. Ambrosy AP, Fonarow GC, Butler J et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63(12): 1123– 1133. doi: 10.1016/ j.jacc.2013.11.053.

2. Butler J, Fonarow GC, Zile MR et al. Developing therapies for heart failure with preserved ejection fraction: current state and future directions. J Am Coll Cardiol Heart Fail 2014; 2(2): 97– 112. doi: 10.1016/ j.jchf.2013.10.006.

3. Vaduganathan M, Michel A, Hall K et al. Spectrum of epidemiological and clinical findings in patients with heart failure with preserved ejection fraction stratified by study design: a systematic review. Eur J Heart Fail 2016; 18(1): 54– 65. doi: 10.1002/ ejhf.442.

4. Senni M, Paulus WJ, Gavazzi A et al. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes. Eur Heart J 2014; 35(40): 2797– 2815. doi: 10.1093/ eurheartj/ ehu204.

5. Greene SJ, Gheorghiade M. Matching mechanism of death with mechanism of action: considerations for drug development for hospitalized heart failure. J Am Coll Cardiol 2014; 64(15): 1599– 1601. doi: 10.1016/ j.jacc.2014.06.1199.

6. Chan MM, Lam CS. How do patients with heart failure with preserved ejection fraction die? Eur J Heart Fail 2013; 15(6): 604– 613. doi: 10.1093/ eurjhf/ hft062.

7. Moss AJ, Hall WJ, Cannom DS et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventriculr arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996; 335(26): 1933– 1940.

8. Vaduganathan M, Patel RB, Shah SJ et al. Sudden cardiac death in heart failure with preserved ejection fraction: a target for therapy? Heart Fail Rev 2016; 21(4): 455– 462. doi: 10.1007/ s10741-016-9525-z.

9. Vaduganathan M, Patel RB, Michel A et al. Mode of death in heart failure with preserved ejection fraction. J Am Coll Cardiol 2017; 69(5): 556– 569. doi: 10.1016/ j.jacc.2016.10.078.

10. Zile MR, Gaasch WH, Anand IS et al. I-PRESERVE Investigators. Mode of death in patients with heart failure and a preserved ejection fraction: results from the Irbesartan in Heart Failure With Preserved Ejection Fraction Study (I-PRESERVE) trial. Circulation 2010; 121(12): 1393– 1405. doi: 10.1161/ CIRCULATIONAHA.109.909614.

11. Solomon SD, Wang D, Finn P et al. Effect of candesartan on cause-specific mortality in heart failure patients: the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) program. Circulation 2004; 110(5): 2180– 2183. doi: 10.1161/ 01.CIR.0000144474.65922.AA.

12. Pitt B, Pfeffer MA, Assmann SF et al. TOPCAT Investigators. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 2014; 370(5): 1383– 1392. doi: 10.1056/ NEJMoa1313731.

13. Adabag S, Smith LG, Anand IS et al. Sudden cardiac death in heart failure patients with preserved ejection fraction. J Card Fail 2012; 18(10): 749– 754. doi: 10.1016/ j.cardfail.2012.08.357.

14. Grigorian-Shamagian L, Otero Raviňa F, Abu Assi E et al. Why and when do patients with heart failure and normal left ventricular ejection fraction die? Analysis of > 600 deaths in a community long-term study. Am Heart J 2008; 156(6): 1184– 1190. doi: 10.1016/ j.ahj.2008.07.011.

15. Hamaguchi S, Kinugawa S, Sobirin MA et al. JCARE-CARD Investigators. Mode of death in patients with heart failure and reduced vs. preserved ejection fraction: report from the registry of hospitalized heart failure patients. Circ J 2012; 76(7): 1662– 1669.

16. Desai AS, McMurray JJ, Packer M et al. Effect of the angiotesin-receptor-neprilysin inhibitor LCZ696 compared with enalapril on mode of death in heart failure patients. Eur Heart J 2015; 36(30): 1990– 1997. doi: 10.1093/ eurheartj/ ehv186.

17. Shah SJ, Gheorghiade M. Heart failure with preserved ejection fraction: treat now by treating comorbidities. JAMA 2008; 300(4): 431– 433. doi: 10.1001/ jama.300.4.431.

18. Fishman GI, Chugh SS, Dimarco JP et al. Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop. Circulation 2010; 122(22): 2335– 2348. doi: 10.1161/ CIRCULATIONAHA.110.976092.

19. Hicks KA, Hung HMJ, Mahaffey KW et al. Standardized data Collection for Cardiovascular Trials Initiative. Standardized definitions for cardiovascular and stroke end point events in clinical trial. CDISC 2014. Available at: https:/ / www.cdisc.org/ system/ files/ all/ reference_material/ application/ pdf/ Draft%20Definitions%20for%20CDISC%20July%203,%202014.pdf.

20. Hicks KA, Tcheng JE, Bozkurt B et al. 2014 ACC/ AHA key data elements and definitions for cardiovascular endpoint events in clinical trials: a report of the American College of Cardiology/ American Heart Association Task Force on Clinical Data Standards (Writing Committtee To Develop Cardiovascular Endpoints Data Standards). J Am Coll Cardiol 2015; 66(4): 403– 469. doi: 10.1016/ j.jacc.2014.12.018.

21. Narang R, Cleland JG, Erhardt L et al. Mode of death in chronic heart failure. A request and proposition for more accurate classification. Eur Heart J1996; 17(9): 1390– 1403.