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      Heart Failure With Preserved Ejection Fraction In Perspective

      Author(s): 1 , 1 , 2
      Publication date Created:
      Publication date (Print):
      Journal: Circulation Research
      Publisher: Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Approximately half of the patients with signs and symptoms of heart failure have a left ventricular ejection fraction that is not markedly abnormal. Despite the historically initial surprise, heightened risks for heart failure specific major adverse events occur across the broad range of ejection fraction, including normal. The recognition of the magnitude of the problem of heart failure with preserved ejection fraction in the past 20 years has spurred an explosion of clinical investigation and growing intensity of informative outcome trials. This article addresses the historic development of this component of the heart failure syndrome, including the epidemiology, pathophysiology, and existing and planned therapeutic studies. Looking forward, more specific phenotyping and even genotyping of subpopulations should lead to improvements in outcomes from future trials.

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          2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

          Piotr Ponikowski, Adriaan A. Voors, Stefan D. Anker … (2016)
          Article 0 comments Cited 2850 times – based on 0 reviews     Review now
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            Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

            Bernard Zinman, Christoph Wanner, John M. Lachin … (2015)
            The effects of empagliflozin, an inhibitor of sodium-glucose cotransporter 2, in addition to standard care, on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known.
            Article 0 comments Cited 2354 times – based on 0 reviews     Review now
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              Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

              Bruce Neal, Vlado Perkovic, Kenneth Mahaffey … (2017)
              Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results The mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% confidence interval [CI], 0.75 to 0.97; P<0.001 for noninferiority; P=0.02 for superiority). Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77). Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation (6.3 vs. 3.4 participants per 1000 patient-years; hazard ratio, 1.97; 95% CI, 1.41 to 2.75); amputations were primarily at the level of the toe or metatarsal. Conclusions In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal. (Funded by Janssen Research and Development; CANVAS and CANVAS-R ClinicalTrials.gov numbers, NCT01032629 and NCT01989754 , respectively.).
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                Author and article information

                Journal
                Title: Circulation Research
                Abbreviated Title: Circ Res
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0009-7330
                ISSN (Electronic): 1524-4571
                Publication date Created: May 24 2019
                Publication date (Print): May 24 2019
                Volume: 124
                Issue: 11
                Pages: 1598-1617
                Affiliations
                [1 ]From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (M.A.P., A.M.S.)
                [2 ]Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B).
                Article
                DOI: 10.1161/CIRCRESAHA.119.313572
                PMC ID: 6534165
                PubMed ID: 31120821
                SO-VID: 5bd51890-c32e-4f9c-b82f-a88ea0de3c28
                Copyright © © 2019
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