Therapeutic Stalemate in Heart Failure With Preserved Ejection Fraction.
The findings of randomized trials of neurohormonal modulation have been neutral in heart failure with preserved ejection fraction and consistently positive in heart failure with reduced ejection. Left ventricular remodeling promotes the development and progression of heart failure with preserved and reduced ejection fraction. However, different stimuli mediate left ventricular remodeling that is commonly concentric in heart failure with preserved ejection fraction and eccentric in heart failure with reduced ejection. The stimuli that promote concentric left ventricular remodeling may account for the neutral findings of neuhormonal modulation in heart failure with preserved ejection fraction. Low-grade systemic inflammation-induced microvascular endothelial dysfunction is currently the leading hypothesis behind the development and progression of heart failure with preserved ejection fraction. The hypothesis provided the rationale for several randomized controlled trials that have led to neutral findings. The trials and their limitations are reviewed.
['Samson|Rohan|R|', 'Le Jemtel|Thierry H|TH|']
D000818:Animals D002317:Cardiovascular Agents D015897:Comorbidity D000082742:Heart Disease Risk Factors D006333:Heart Failure D006352:Heart Ventricles D006801:Humans D007249:Inflammation D018836:Inflammation Mediators D020127:Recovery of Function D018570:Risk Assessment D015398:Signal Transduction D013318:Stroke Volume D016896:Treatment Outcome D016277:Ventricular Function, Left D020257:Ventricular Remodeling
left ventricular remodeling HFpEF coronary microvascular dysfunction systemic inflammation