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Cited by 355Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsCardiovascular and exercise physiology

Heart failure with preserved ejection fraction: from mechanisms to therapies

Lam, Carolyn S P, Voors, Adriaan A, de Boer, Rudolf A, Solomon, Scott D, van Veldhuisen, Dirk J·2018·European Heart Journal
DOI 10.1093/eurheartj/ehy301
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Abstract

This review aims to provide a translational perspective on recent developments in heart failure with preserved ejection fraction (HFpEF), linking mechanistic insights to potential therapies. A key concept in this review is that HFpEF is a haemodynamic condition wherein the heart fails to keep up with the circulatory demands of the body, or does so at the expense of raised left ventricular filling pressures. We, therefore, propose that the 'final common pathway' for development of congestion, i.e. basic haemodynamic mechanisms of increased left ventricular end-diastolic pressure, left atrial hypertension, pulmonary venous congestion, and plasma volume expansion, represents important initial targets for therapy in HFpEF. Accordingly, we group this review into six mechanisms translating into potential therapies for HFpEF: beginning with three haemodynamic mechanisms (left atrial hypertension, pulmonary hypertension, and plasma volume expansion), and working backward to three potential molecular mechanisms [systemic microvascular inflammation, cardiometabolic functional abnormalities, and cellular (titin)/extracellular (fibrosis) structural abnormalities].

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  • Hypertension is often a precursor of heart failure of either type, ASCVD can coexist with either type, and prior myocardial infarction is often a major factor in heart failure with reduced ejection fraction.

    “Hypertension is often a precursor of heart failure of either type, and ASCVD can coexist with either type (7), whereas prior myocardial infarction (MI) is often a major factor in HFrEF.”

    From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [7]

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Authors
Lam, C. S. P., Voors, A. A., de Boer, R. A., Solomon, S. D., & van Veldhuisen, D. J.
Affiliations
  • University Medical Center Groningen (NL)
  • Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, Hanzeplein 1, Groningen, the Netherlands
  • Brigham and Women's Hospital (US)
Corresponding author
Lam, Carolyn S P
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2018-06-13
Volume
39
Issue
30
Pages
2780-2792
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehy301
OpenAlex
W2808403888
Cited by
355
References
139
Citations by year
2026: 29 · 2025: 27 · 2024: 38 · 2023: 36 · 2022: 52 · 2021: 61 · 2020: 63 · 2019: 41 · 2018: 5 · 2017: 1
FWCI
7.93
Type
journal article
Language
en
Open access
closed
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor, 1 d)
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders
  • Amgen
  • Bristol-Myers Squibb
  • Pfizer
  • AstraZeneca
  • Sanofi
  • Gilead Sciences
  • Alnylam Pharmaceuticals
  • Boston Scientific Corporation
  • Celladon Corporation
  • Ironwood Pharmaceuticals, Incorporated
  • Cytokinetics
  • MyoKardia
  • ARCA Biopharma
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (917.13.350, NWO VIDI, grant 917.13.350)
  • Universitair Medisch Centrum Groningen
  • Vifor Pharma
  • Servier
  • National Institutes of Health
  • Abbott Diagnostics
  • Sanofi Pasteur
  • Medical Research Council
  • National Medical Research Council
  • National Heart, Lung, and Blood Institute
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
heart failure with preserved ejection fraction, hemodynamics, left ventricular end-diastolic pressure, left atrial hypertension, pulmonary hypertension, plasma expansion, pulmonary venous congestion, microvascular inflammation, cardiometabolic dysfunction, titin, myocardial fibrosis, therapeutic target
MeSH terms
Heart Failure, Humans, Stroke Volume

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