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Heart Failure with Preserved Ejection Fraction (HEFPEF) (Research…
Heart Failure with Preserved Ejection Fraction (HEFPEF)
diagnosis
(Paulus et al 2007)
normal systolic function, > 50% EF and LVEDVI < 97 mL/m^2
LVEDVI is end diastolic volume of left ventricle indexed by body surface area
symptoms of congestive heart failure (ankle swelling, pulmonary oedema, fatigue, )
diastolic dysfunction
invasive EDP > 16 mmHg or pulmonary capillary wedge pressure > 12 mmHg
non-invasive tissue doppler E/E' >15
Data sources
echo
doppler fluid velocities
volume
CMR
volume
Pressure cathers
therapies
In contrast to HFrEF, clinical trials with pharmacological agents show limited success
Borlaug 2010
prevelance
50% of heart failure patients
prognosis
Owan et al 2006
5 year survival < %40
Research Questions
How are HEFPEF and HEFREF related?
Can the diagnosis or part of the diagnosis of HEFPEF be automated?
Are there distinct phenotypes with different prognosis and/or traits?
ML 3 distinct phenotypes with differing level of risk
(Shat et al 2015)
How can we predict risk or prognosis?
#
Poisson Regression, 39 372 patients, lower EF and 13 other predictors of mortality
MAGGIC risk score
What can we learn from PV loops?
Mechanics
Reduced LAX function and increased SAX function
(Paulus et al 2007)
PV -Loop Phenomena
Elevated End Systolic Elastance
Borlaug 2010
Lack of cardiac output increase in exercise due to slower heart rates (chronotopic incompetance) and smaller stroke volume
Borlaug 2010
diastolic stiffness
extracellular matrix
2/3 patients have abormally high collagen levels
Borbely 2005
High extracellular volume fraction (diffuse fibrosis)
Webb 2018
cardiomyocytes
titin-isoform switching less stiff to more stiff
Borlaug 2010
Lack of energy to power crossbridge detachment
Borlaug 2010
risk factors
hypertension
(Shah et al 2014
)
diabetes
consequences
exercise intolerance