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- Title
Treatment of heart failure with a preserved ejection fraction.
- Authors
Yuran Ahn; Jong-Chan Youn
- Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent, is associated with high morbidity, and has very few effective treatments. Current Concepts: HFpEF is a heterogeneous syndrome arising from the interplay of cardiac (diastolic, systolic dysfunction, pulmonary hypertension, right ventricular dysfunction, left atrial dysfunction, and chronotropic incompetence) and extracardiac (endothelial dysfunction, skeletal muscle abnormality, pulmonary disease, and renal dysfunction) abnormalities. Although various pharmacological therapies of HFpEF have been introduced and studied, most of them showed a limited clinical benefit. With some advancement in the specific phenotype of HFpEF, diuretics, mineralocorticoid antagonists, sacubitril/valsartan, and lifestyle modifications are recommended as important treatments. Recently, EMPEROR-Preserved trials showed that empagliflozin reduced the combined risk of cardiovascular death or hospitalization for patients with HFpEF, regardless of the presence or absence of diabetes. Several non-pharmacological therapies, including interatrial septal shunt and pacing therapies, have been introduced and are under investigation. Discussion and Conclusion: HFpEF has been recognized as the single greatest unmet need in cardiovascular medicine. Further research is required to understand the concrete pathophysiology for each phenotype of HFpEF. Prevention and management of comorbidities and risk factors for HFpEF are of great importance. Sodium-glucose cotransporter 2 inhibitors may contribute to a change in clinical practice, given the lack of therapeutic options available for patients with HFpEF.
- Subjects
HEART failure treatment; DIURETICS; SODIUM-glucose cotransporters; VENTRICULAR ejection fraction; EMPAGLIFLOZIN; MINERALOCORTICOIDS; HEALTH behavior; VALSARTAN; STROKE volume (Cardiac output); BEHAVIOR modification; PHENOTYPES; CHEMICAL inhibitors
- Publication
Journal of the Korean Medical Association / Taehan Uisa Hyophoe Chi, 2022, Vol 65, Issue 1, p18
- ISSN
1975-8456
- Publication type
Article
- DOI
10.5124/jkma.2022.65.1.18