scholarly journals Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

2017 ◽  
Vol 20 (1) ◽  
pp. 16-37 ◽  
Author(s):  
Thomas M. Gorter ◽  
Dirk J. van Veldhuisen ◽  
Johann Bauersachs ◽  
Barry A. Borlaug ◽  
Jelena Celutkiene ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
European Society ◽  
Position Statement ◽  
Preserved Ejection Fraction ◽  
Right Heart ◽  
Heart Dysfunction ◽  
European Society Of Cardiology ◽  
Right Heart Dysfunction ◽  
Management Position

scholarly journals Right Heart Dysfunction in Heart Failure With Preserved Ejection Fraction: The Impact of Atrial Fibrillation

2018 ◽  
Vol 24 (3) ◽  
pp. 177-185 ◽  
Author(s):  
Thomas M. Gorter ◽  
Joost P. van Melle ◽  
Michiel Rienstra ◽  
Barry A. Borlaug ◽  
Yoran M. Hummel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Right Heart ◽  
Heart Dysfunction ◽  
Right Heart Dysfunction ◽  
The Impact

scholarly journals Right heart dysfunction in heart failure with preserved ejection fraction

2014 ◽  
Vol 35 (48) ◽  
pp. 3452-3462 ◽  
Author(s):  
Vojtech Melenovsky ◽  
Seok-Jae Hwang ◽  
Grace Lin ◽  
Margaret M. Redfield ◽  
Barry A. Borlaug
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Right Heart ◽  
Heart Dysfunction ◽  
Right Heart Dysfunction

scholarly journals Approach to the Treatment of Heart Failure With Preserved Ejection Fraction and Mid- Range Ejection Fraction

2017 ◽  
Vol 10 ◽  
Author(s):  
Ewa A Jankowska ◽  
Andrew JS Coats ◽  
Stefan D Anker
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Ejection Fraction ◽  
European Society ◽  
Preserved Ejection Fraction ◽  
The Future ◽  
European Society Of Cardiology ◽  
Agreed Definition

In this article we discuss the treatment of heart failure (HF) with preserved ejection fraction (HFpEF) and of HF with mid-range ejection fraction (HFmrEF) as has received considerable interest since the publciation of the 2016 European Society of Cardiology (ESC) heart failure guidelines. Since clinical trials on HFpEF have included also patients with HFmrEF, due to the lack of an agreed definition, the ESC recommendations here described apply to both phenotypes. As a consequence of the recent characterisation of this HF syndrome, it is expected that upcoming research will provide data specifically regarding HFmrEF and tailored recommendations will be developed in the future.

scholarly journals Malnutrition, congestion and mortality in ambulatory patients with heart failure

Heart ◽  
2018 ◽  
Vol 105 (4) ◽  
pp. 297-306 ◽  
Author(s):  
Shirley Sze ◽  
Pierpaolo Pellicori ◽  
Jufen Zhang ◽  
Andrew L Clark
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Right Heart ◽  
Heart Dysfunction ◽  
Nutritional Risk Index ◽  
Ambulatory Patients ◽  
Right Heart Dysfunction

BackgroundIn patients with chronic heart failure (CHF), malnutrition might be related to right heart dysfunction and venous congestion, which predispose to bowel oedema and malabsorption, thereby leading to malnutrition. We explored the relation between congestion, malnutrition and mortality in a large cohort of ambulatory patients with CHF.MethodsWe assessed malnutrition using the Geriatric Nutritional Risk Index (GNRI). Congestion was defined by echocardiography (raised right atrial pressure (RAP)=dilated inferior vena cava≥21 mm/raised pulmonary artery systolic pressure (PAsP)=transtricuspid gradient of ≥36 mm Hg/right ventricular systolic dysfunction (RVSD)=tricuspid annular plane systolic excursion <17 mm).ResultsOf the 1058 patients enrolled, CHF was confirmed in 952 (69% males, median age 75 (IQR: 67–81) years, median N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) 1141 (IQR: 465–2562) ng/L). 39% had HF with -reduced ejection fraction (left ventricular ejection fraction, LVEF <40%) and 61% had HF with normal (HeFNEF, LVEF ≥40% and NT-pro-BNP >125 ng/L) ejection fraction. Overall, 14% of patients were malnourished (GNRI ≤98). 35% had raised RAP, 23% had raised PAsP and 38% had RVSD. Congestion was associated with malnutrition. During a median follow-up of 1683 days (IQR: 1096–2230 days), 461 (44%) patients died. Malnutrition was an independent predictor of mortality. Patients who were malnourished with both RVSD and increased RAP had much worse outcome compared with non-malnourished patients without RVSD who had normal RAP.ConclusionMalnutrition and congestion are modestly correlated and each is independently associated with increased mortality in patients with CHF. Patients with HF with both malnutrition and congestion as evidenced by right heart dysfunction should be managed with additional vigilance.

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