Immuno-haemostatic dysregulation in heart failure with preserved ejection fraction.

Aims: Heart failure with preserved ejection fraction (HFpEF) is a complex condition with partially unclear pathophysiology, in which systemic inflammation is a central contributor to changes in cardiac structure and function. The contribution of non-traditional immune effectors-such as platelets and coagulation-remains underexplored in HFpEF. We characterized platelet function, as well as coagulation and neutrophil activation, in patients with HFpEF.

The diagnostic yield of an elaborate workup for comorbidities in a real-life HFpEF outpatient population.

Background: Comorbidities play an important role in heart failure with preserved ejection fraction (HFpEF). Still, current guidelines lack clear directives for routine comorbidity screening and are primarily based on HF with reduced ejection fraction populations.

Objective: This study evaluates the diagnostic yield of standardized routine work-up for comorbidities in HFpEF.

Time to screen: rationale and roadmap for HFpEF screening in individuals with obesity.

Obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and is associated with a distinct pathophysiological phenotype. Individuals with obesity develop HFpEF on average a decade earlier than individuals without obesity. Despite this, systematic screening for HFpEF in individuals with obesity is not currently recommended in clinical guidelines.

A simplified approach for diagnosing heart failure with preserved ejection fraction by assessing the left atrium and natriuretic peptides.

Aims: Heart failure with preserved ejection fraction (HFpEF) is common but diagnosing it remains cumbersome and complex. Left atrial (LA) enlargement and dysfunction is an important pathologic marker in HFpEF. We evaluated whether LA measures and circulating natriuretic peptides (NPs) could simplify HFpEF diagnosis as a first step.

Prevalence of transthyretin amyloid cardiomyopathy in an unselected cohort with heart failure with preserved ejection fraction.

Introduction: Heart failure with preserved ejection fraction (HFpEF) represents a heterogeneous syndrome characterised by various underlying aetiologies, such as transthyretin amyloid cardiomyopathy (ATTR-CM). The aim of this study was to determine the true prevalence of ATTR-CM in a Dutch all-comers cohort of HFpEF patients.

Methods: From 2018 to 2023, all patients diagnosed with HFpEF underwent prospective screening for ATTR-CM.

The effect of empagliflozin on peripheral microvascular dysfunction in patients with heart failure with preserved ejection fraction.

Background: Empagliflozin is an effective treatment for heart failure with preserved ejection fraction (HFpEF), but its definite mechanism of action is unclear. Systemic microvascular dysfunction strongly relates to HFpEF aetiology, and we hypothesised that empagliflozin improves microvascular function in HFpEF.

Objective: To investigate the effect of the sodium-glucose cotransporter-2 inhibitor empagliflozin on peripheral microvascular function in HFpEF.

Peroxiredoxin-4, a marker of systemic oxidative stress, is associated with incident heart failure.

Aims: Oxidative stress is known to be involved in the pathophysiology of heart failure (HF). To assess oxidative stress, direct quantification of reactive oxygen species would be ideal but this is not feasible due to their short half-lives. Antioxidant enzymes such as peroxiredoxins, produced as a direct response to oxidative stress, mirror the process and can be more easily quantified.

Temporal prevalence and prognostic impact of diabetes mellitus and albuminuria in heart failure with preserved ejection fraction.

Background: Most patients with heart failure with preserved ejection fraction (HFpEF) have a metabolic phenotype in which comorbidities including diabetes mellitus play an important role. Factors related to impaired glucose metabolism, such as kidney disease, may contribute to adverse clinical events. Albuminuria is an early marker of kidney disease.

Prevalence and prognostic value of ventricular conduction delay in heart failure with preserved ejection fraction.

Background: The pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF) is heterogeneous and incompletely understood. This study evaluated the presence of a ventricular conduction delay (VCD) phenotype in HFpEF through QRS duration and vectorcardiographic QRS area, and their relation to adverse outcomes.

Methods: This study included consecutive ambulatory HFpEF patients.

Prognostic value of hypoxaemic burden from overnight oximetry in heart failure with preserved ejection fraction.

Aims: Nocturnal hypoxaemic burden, quantified as time spent with oxygen saturation below 90% (T90), is an established independent predictor of mortality in heart failure (HF) with reduced ejection fraction. The prognostic value of T90 in HF with preserved ejection fraction (HFpEF) is unknown. This study aims to determine the association of T90 with adverse outcomes in HFpEF.

Diversity of heart failure phenotypes in transthyretin amyloid cardiomyopathy. More than just heart failure with preserved ejection fraction.

Introduction: Current guidelines recommend suspecting transthyretin amyloid cardiomyopathy (ATTR-CM) in patients over 65 years of age with unexplained left ventricular (LV) hypertrophy in a non-dilated LV, heart failure (HF) and preserved ejection fraction (HFpEF), hypertrophic cardiomyopathy or severe aortic stenosis. However, there is evidence indicating a high prevalence of ATTR-CM in other HF phenotypes. As such, this study aimed to characterize the diversity of HF phenotypes of ATTR-CM by examining the LV ejection fraction and LV dilatation using echocardiography.

Changes in the diagnostic trajectory of transthyretin cardiac amyloidosis over six years.

Awareness of transthyretin amyloid cardiomyopathy (ATTR-CM) has increased over the years due to diagnostic and therapeutic developments. Timely initiation of novel disease-modifying treatments improves both morbidity and mortality, which underlines the necessity for a prompt diagnosis. Nevertheless, early diagnosis of ATTR-CM remains challenging.

Association between phonocardiography and echocardiography in heart failure patients with preserved ejection fraction.

Aims: Heart failure with preserved ejection fraction (HFpEF) is associated with stiffened myocardium and elevated filling pressure that may be captured by heart sound (HS). We investigated the relationship between phonocardiography (PCG) and echocardiography in symptomatic patients suspected of HFpEF.

Methods And Results: Consecutive symptomatic patients with sinus rhythm and left ventricular ejection fraction >45% were enrolled.