Update: Herzinsuffizienz mit erhaltener Pumpfunktion

Was ist neu?

Diagnosestellung Die 2021 erschienene Herzinsuffizienz-Leitlinie der Europäischen Gesellschaft für Kardiologie (ESC) hat die Diagnosestellung etwas vereinfacht. Sie listet die Diagnosekriterien gleichwertig, ohne das Vorliegen einer bestimmten Anzahl von Kriterien zu fordern.

Ätiologie Eine Expertengruppe der Herzinsuffizienz-Vereinigung (HFA: Heart Failure Association) und der Rhythmus-Vereinigung (EHRA: European Heart Rhythm Association) der ESC sowie der Europäischen Gesellschaft für Hypertonie unternahm den Versuch, durch detaillierte Phänotypisierung pathophysiologisch und therapeutisch distinkte Profile an HFpEF-Patienten herauszuarbeiten.

Therapie In einem unlängst erschienenen Update der Leitlinie wurden auf der Basis neu gewonnener Evidenz erstmals konkrete Empfehlungen zur Pharmakotherapie der HFpEF formuliert. Die Kontrolle der Risikofaktoren und ein gesunder Lebensstil bleiben weiterhin von großer therapeutischer Bedeutung.

Abstract

Heart failure with a preserved ejection fraction (HFpEF) is a multifaceted disease entity. Confirming the diagnosis as well as tailoring the most appropriate therapy remains an ongoing challenge. The 2021 heart failure guidelines of the European Society of Cardiology (ESC) suggested a simplified diagnostic approach, and the guideline update provided in 2023 gave recommendations regarding pharmacotherapy based on recent evidence. Further, the Heart Failure Association (HFA) and the European Heart Rhythm Association of the ESC jointly proposed a scheme how to classify HFpEF patients into phenogroups of distinct pathophysiology that may benefit from individually targeted treatment. Regarding HFpEF originating from secondary causes, e.g. M. Fabry, amyloidosis or hypertrophic cardiomyopathy, there are emerging therapeutic options with the potential to substantially improve the physical capacity, quality of life and prognosis in these patients. The here presented update gives an overview on the recent advances in the area of HFpEF.

Schlüsselwörter

Herzinsuffizienz mit erhaltener Pumpfunktion - HFpEF - Phänotyp - Diagnose - Therapie

Keywords

Heart failure with preserved ejection fraction - HFpEF - phenogroup - diagnosis - therapy

Publikationsverlauf

Artikel online veröffentlicht:
27. Februar 2024

• Literatur

• 1 McDonagh TA, Metra M, Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42: 3599-3726
• 2 Pieske B, Tschope C, de Boer RA. et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2019; 40: 3297-3317
• 3 McDonagh TA, Metra M, Adamo M. et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2023;
• 4 Anker SD, Usman MS, Anker MS. et al. Patient phenotype profiling in heart failure with preserved ejection fraction to guide therapeutic decision making. A scientific statement of the Heart Failure Association, the European Heart Rhythm Association of the European Society of Cardiology, and the European Society of Hypertension. Eur J Heart Fail 2023; 25: 936-955
• 5 Koschker AC, Warrings B, Morbach C. et al. Effect of bariatric surgery on cardio-psycho-metabolic outcomes in severe obesity: A randomized controlled trial. Metabolism 2023; 147: 155655
• 6 Kosiborod MN, Abildstrom SZ, Borlaug BA. et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med 2023; 389: 1069-1084
• 7 Solomon SD, Claggett B, Lewis EF. et al. Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J 2016; 37: 455-462
• 8 Solomon SD, McMurray JJV, Anand IS. et al. Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. N Engl J Med 2019; 381: 1609-1620
• 9 Solomon SD, Vaduganathan M, Claggett BL. et al. Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure. Circulation 2020; 141: 352-361
• 10 Wehner GJ, Jing L, Haggerty CM. et al. Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie?. Eur Heart J 2020; 41: 1249-1257
• 11 Huang Z, Jiang Y, Zhou Y. Heart Failure with Supra-normal Left Ventricular Ejection Fraction – State of the Art. Arq Bras Cardiol 2021; 116: 1019-1022
• 12 Arbelo E, Protonotarios A, Gimeno JR. et al. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44: 3503-3626
• 13 Verheyen N, Batzner A, Zach D. et al. Spatial relationship between mitral valve and ventricular septum assessed by resting echocardiography to diagnose left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24: 710-718
• 14 Anker SD, Butler J, Filippatos G. et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med 2021; 385: 1451-1461
• 15 Solomon SD, McMurray JJV, Claggett B. et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med 2022; 387: 1089-1098
• 16 Bhatt DL, Szarek M, Pitt B. et al. Sotagliflozin in Patients with Diabetes and Chronic Kidney Disease. N Engl J Med 2021; 384: 129-139
• 17 Filippatos G, Butler J, Farmakis D. et al. Empagliflozin for Heart Failure With Preserved Left Ventricular Ejection Fraction With and Without Diabetes. Circulation 2022; 146: 676-686
• 18 Vaduganathan M, Docherty KF, Claggett BL. et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet 2022; 400: 757-767
• 19 Bohm M, Butler J, Filippatos G. et al. Empagliflozin Improves Outcomes in Patients With Heart Failure and Preserved Ejection Fraction Irrespective of Age. J Am Coll Cardiol 2022; 80: 1-18
• 20 Abraham WT, Adamson PB, Bourge RC. et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 2011; 377: 658-666
• 21 Angermann CE, Assmus B, Anker SD. et al. Pulmonary artery pressure-guided therapy in ambulatory patients with symptomatic heart failure: the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF). Eur J Heart Fail 2020; 22: 1891-1901
• 22 Pieroni M, Moon JC, Arbustini E. et al. Cardiac Involvement in Fabry Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 77: 922-936
• 23 Wechalekar AD, Fontana M, Quarta CC. et al. AL Amyloidosis for Cardiologists: Awareness, Diagnosis, and Future Prospects: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2022; 4: 427-441
• 24 Yilmaz A, Bauersachs J, Bengel F. et al. Diagnosis and treatment of cardiac amyloidosis: position statement of the German Cardiac Society (DGK). Clin Res Cardiol 2021; 110: 479-506
• 25 Olivotto I, Oreziak A, Barriales-Villa R. et al. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2020; 396: 759-769