Relation of microvascular dysfunction and exercise tolerance in patients with heart failure with preserved ejection fraction

2020 ◽  
Vol 37 (8) ◽  
pp. 1192-1198 ◽  
Author(s):  
Ragab A. Mahfouz ◽  
Mohammad Gouda ◽  
Mohamed Abdelhamid
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Tolerance ◽  
Microvascular Dysfunction ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

scholarly journals Clinical Utility of Exercise Training in Heart Failure with Reduced and Preserved Ejection Fraction

2015 ◽  
Vol 9 ◽  
pp. CMC.S21372 ◽  
Author(s):  
Muhammad Asrar Ul Haq ◽  
Cheng Yee Goh ◽  
Itamar Levinger ◽  
Chiew Wong ◽  
David L. Hare
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Exercise Tolerance ◽  
Exercise Intolerance ◽  
Sufficient Evidence ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed.

Angiographic Evaluation of Coronary Microvascular Dysfunction in Patients with Heart Failure and Preserved Ejection Fraction

2015 ◽  
Vol 22 (7) ◽  
pp. 528-533 ◽  
Author(s):  
Vincenzo Sucato ◽  
Salvatore Evola ◽  
Giuseppina Novo ◽  
Angela Sansone ◽  
Angelo Quagliana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

scholarly journals Impact of Interatrial Shunts on Invasive Hemodynamics and Exercise Tolerance in Patients With Heart Failure

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Jan M. Griffin ◽  
Barry A. Borlaug ◽  
Jan Komtebedde ◽  
Sheldon E. Litwin ◽  
Sanjiv J. Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Tolerance ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Alternative Means ◽  
Interatrial Shunt

Approximately 50% of patients with heart failure have preserved ejection fraction. Although a wide variety of conditions cause or contribute to heart failure with preserved ejection fraction, elevated left ventricular filling pressures, particularly during exercise, are common to all causes. Acute elevation in left‐sided filling pressures promotes lung congestion and symptoms of dyspnea, while chronic elevations often lead to pulmonary vascular remodeling, right heart failure, and increased risk of mortality. Pharmacologic therapies, including neurohormonal modulation and drugs that modify the nitric oxide/cyclic GMP‐protein kinase G pathway have thus far been limited in reducing symptoms or improving outcomes in patients with heart failure with preserved ejection fraction. Hence, alternative means of reducing the detrimental rise in left‐sided heart pressures are being explored. One proposed method of achieving this is to create an interatrial shunt, thus unloading the left heart at rest and during exercise. Currently available studies have shown 3‐ to 5‐mm Hg decreases of pulmonary capillary wedge pressure during exercise despite increased workload. The mechanisms underlying the hemodynamic changes are just starting to be understood. In this review we summarize results of recent studies aimed at elucidating the potential mechanisms of improved hemodynamics during exercise tolerance following interatrial shunt implantation and the current interatrial shunt devices under investigation.

scholarly journals Mechanisms of exercise intolerance in patients with heart failure and preserved ejection fraction. Part II: The role of right heart chambers, vascular system and skeletal muscles

Kardiologiia ◽  
2019 ◽  
Vol 59 (8S) ◽  
pp. 4-14
Author(s):  
A. G. Ovchinnikov ◽  
A. V. Potekhina ◽  
N. M. Ibragimova ◽  
E. A. Barabanova ◽  
E. N. Yushchyuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Exercise Tolerance ◽  
Vascular System ◽  
Exercise Intolerance ◽  
Preserved Ejection Fraction ◽  
Right Heart ◽  
Patients With Heart Failure ◽  
The Right

The main clinical manifestation of heart failure with preserved ejection fraction is poor exercise tolerance. In addi-tion to the dysfunction of the left heart chambers, which were presented in the first part of this review, many other disorders are involved in poor exercise tolerance in such patients: impairments of the right heart, vascular system and skeletal muscle. The second part of this review presents the mechanisms for the development of these disorders, as well as possible ways to correct them.

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