Keywords
How to Cite
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a multifaceted disease resulting from a wide range of comorbidities. Obesity and diabetes are the main factors in the formation of HFpEF due to increased epicardial adipose tissue (EAT) volume. Stratification of HFpEF patients based on phenotypes leads to new classifications, including HFpEF phenotypes with obesity and DM. There is a close relationship between EAT volume and HFpEF. Patients with HFpEF can be further classified according to EAT volume using advanced imaging techniques, including сardiovascular magnetic resonance and computed tomography. EAT functions as an endocrine tissue that promotes myocardial inflammation. In addition, EAT dilatation acts as a spaceoccupying lesion, resulting in decreased functional pericardial volume, increased ventricular filling pressure, and increased ventricular coupling (interaction). Nonpharmacological lifestyle interventions, lipid-lowering therapy, and fat-modulating antidiabetic agents such as metformin, sodium-glucose cotransporter-2 inhibitors, or glucagon-like peptide 1 agonists are capable of inducing EAT regression may be particularly effective for this subgroup of patients. The direct effects of sodiumglucose
cotransporter-2 inhibitor, and glucagon-like peptide-1 agonist on HFpEF are currently under clinical investigation. Clinical trial data indicate that morbidity and long-term mortality rates in type 2 diabetes patients with HFpEF are higher than in patients without diabetes. One of the major obstacles to the clinical therapy for HFpEF is the poorly understood pathophysiology of HFpEF, making drug development a challenging task. Several potential therapeutic targets have currently been identified. Thus, upcoming drug development requires a more comprehensive approach not only for the comorbidities of HFpEF, but also for its classification and phenotypic identification.
References
Fopiano KA, Jalnapurkar S, Davila AC, Arora V, Bagi Z. Coronary microvascular dysfunction and heart failure with preserved ejection fraction – implications for chronic inflammatory mechanisms. Curr Cardiol Rev. 2022;18(2):e310821195986. doi: 10.2174/1573403X17666210831144651.
Dhore-Patil A, Thannoun T, Samson R, Le Jemtel TH. Diabetes mellitus and heart failure with preserved ejection fraction: role of obesity. Front Physiol. 2022 Feb 15;12:785879. doi: 10.3389/fphys.2021.785879.
Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020 Sep;17(9):559-73. doi: 10.1038/s41569-020-0363-2.
Borlaug BA, Jensen MD, Kitzman DW, Lam CSP, Obokata M, Rider OJ. Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets. Cardiovasc Res. 2023 Feb 3;118(18):3434-50. doi: 10.1093/cvr/cvac120.
Redfield MM, Borlaug BA. Heart failure with preserved ejection fraction: a review. JAMA. 2023 Mar 14;329(10):827-38. doi: 10.1001/jama.2023.2020.
Mishra S, Kass DA. Cellular and molecular pathobiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2021Jun;18(6):400-23. doi: 10.1038/s41569-020-00480-6.
McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6. doi: 10.1056/NEJM197112232852601.
Adamo M, Gardner RS, McDonagh TA, Metra M. The 'Ten Commandments' of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2022 Feb 10;43(6):440-1. doi: 10.1093/eurheartj/ehab853.
Parra-Lucares A, Romero-Hernández E, Villa E, Weitz-Muñoz S, Vizcarra G, Reyes M, et al. New Opportunities in heart failure with preserved ejection fraction: from bench to bedside … and back. Biomedicines. 2022 Dec 27; 11(1):70. doi: 10.3390/biomedicines11010070.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun, Colvin MM, et al. AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022 May 3;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063.
Kessler EL, Oerlemans MI, Hoogen PVD, Yap C, Sluijter JP, de Jager SC. Immunomodulation in heart failure with preserved ejection fraction: current state and future perspectives. J. Cardiovasc. Transl. Res. 2021 Feb;14(1):63-74. doi: 10.1007/s12265-020-10026-3.
Sweeney M, Corden B, Cook SA. Targeting cardiac fibrosis in heart failure with preserved ejection fraction: Mirage or miracle? EMBO Mol. Med. 2020 Oct 7;12(10):e10865. doi: 10.15252/emmm.201910865.
Frisk M, Le C, Shen X, Røe ÅT, Hou Y, Manfra O, et al. Etiologydependent impairment of diastolic cardiomyocyte calcium homeostasis in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2021 Feb 2;77(4):405-19. doi: 10.1016/j.jacc.2020.11.044.
Frljak S, Poglajen G, Vrtovec B. Cell therapy in heart failure with preserved ejection fraction. Card Fail Rev. 2022 Mar 21;8:e08. doi: 10.15420/cfr.2021.21.
Sokolova LK, Pushkarev VM, Belchina YuB, Pushkarev VV, Furmanova OV, Cherviakova SA, et al. NT-proBNP blood levels in patients with type 2 diabetes mellitus with anemia and after the dapagliflozin treatment. Dopov Nats Akad Nauk Ukr. 2018;(11):91-5. doi: 10.15407/dopovidi2018.11.091.