Abstract:
:The majority of older patients who develop heart failure (HF), particularly older women, have a preserved left ventricular ejection fraction (HFpEF). Patients with HFpEF have severe symptoms of exercise intolerance, poor quality-of-life, frequent hospitalizations, and increased mortality. The prevalence of HFpEF is increasing and its prognosis is worsening. However, despite its importance, our understanding of the pathophysiology of HFpEF is incomplete, and drug development has proved immensely challenging. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. Originally viewed as a disorder due solely to abnormalities in left ventricular (LV) diastolic function, our understanding has evolved such that HFpEF is now understood as a systemic syndrome, involving multiple organ systems, likely triggered by inflammation and with an important contribution of aging, lifestyle factors, genetic predisposition, and multiple-comorbidities, features that are typical of a geriatric syndrome. HFpEF is usually progressive due to complex mechanisms of systemic and cardiac adaptation that vary over time, particularly with aging. In this review, we examine evolving data regarding HFpEF that may help explain past challenges and provide future directions to care patients with this highly prevalent, heterogeneous clinical syndrome.
journal_name
Clin Cardioljournal_title
Clinical cardiologyauthors
Upadhya B,Kitzman DWdoi
10.1002/clc.23321subject
Has Abstractpub_date
2020-02-01 00:00:00pages
145-155issue
2eissn
0160-9289issn
1932-8737journal_volume
43pub_type
杂志文章,评审abstract::As I advanced through medical school at Johns Hopkins, and throughout my subsequent training, I was constantly reminded of the contributions made to medicine by our predecessors. Many of whom were at Johns Hopkins, but many were not. As I continue active involvement in the education of medical students and physicians,...
journal_title:Clinical cardiology
pub_type: 社论,历史文章
doi:10.1002/clc.20392
更新日期:2008-04-01 00:00:00
abstract::Left ventricular systolic dysfunction (LVSD) and clinical heart failure are common complications of acute myocardial infarction (AMI) and result in substantially increased mortality and morbidity. Evidence-based cardiovascular protective therapies, including angiotensin-converting enzyme inhibitors, beta blockers, ant...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960290103
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Little is known about the relationship of body fluid status with the levels and fluctuations of B-type natriuretic peptide (BNP) over the long-term. HYPOTHESIS:If BNP is to become useful for monitoring of patients with chronic heart failure (HF), the levels should reliably reflect both decompensation and im...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960291008
更新日期:2006-10-01 00:00:00
abstract::The combination of cilostazol, aspirin, and clopidogrel (triple therapy) after percutaneous coronary intervention has been considered as an alternative therapy. We performed a meta-analysis based on 8 randomized controlled trials with a total of 3332 patients to compare the effectiveness and safety of this triple ther...
journal_title:Clinical cardiology
pub_type: 杂志文章,meta分析,评审
doi:10.1002/clc.22001
更新日期:2012-10-01 00:00:00
abstract::Various types of pulmonary venous return abnormalities have been described in the literature. This report presents a case in which a 4-h-old neonate presented with cyanotic heart disease and respiratory distress. This neonate was subsequently shown to have complete absence of the pulmonary veins (CAPV), a previously u...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960110415
更新日期:1988-04-01 00:00:00
abstract::Infusion of dobutamine in low and high doses in combination with echocardiography can be used for the assessment of myocardial viability and functional significance of coronary artery disease. Improvement of contractile function of hypokinetic or akinetic ventricular wall segment with low-dose dobutamine has a high pr...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960180506
更新日期:1995-05-01 00:00:00
abstract::Five multicenter, randomized, double-blind, placebo-controlled studies were conducted in France to compare the efficacy and safety of once-daily simvastatin treatment (10-40 mg/day) with conventional therapy with gemfibrozil 900 mg/day, ciprofibrate 100 mg/day, bezafibrate 400 mg/day, and fenofibrate 300 or 400 mg/day...
journal_title:Clinical cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1002/clc.4960181107
更新日期:1995-11-01 00:00:00
abstract::In patients with malignant ventricular arrhythmias, antiarrhythmic therapy is known to carry a substantial risk of proarrhythmia. This risk is usually considered to be low when supraventricular arrhythmias or benign ventricular arrhythmias are considered. We were able to collect data on four patients without a history...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960170410
更新日期:1994-04-01 00:00:00
abstract::Flecainide is reported to be effective in patients with paroxysmal tachycardias, but its effect on rapid ventricular response over accessory atrioventricular pathway during atrial fibrillation is not known. The influence of flecainide on various electrophysiological properties of the accessory pathway with special emp...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960080603
更新日期:1985-06-01 00:00:00
abstract::Since the initial report of balloon coarctation angioplasty in 1982, several workers used this technique in native coarctation and postoperative recoarctation. Immediate and intermediate-term follow-up results are generally good with a small chance for recoarctation and aneurysmal formation at the site of coarctation....
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960121103
更新日期:1989-11-01 00:00:00
abstract:BACKGROUND:In many cardiac catheterization laboratories interventional procedures are performed at a date later than the diagnostic study, causing increased hospital days and costs. Few data exist which compare procedural success, complications, and costs between procedures performed at the time of diagnostic study and...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960230505
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND:There is a growing body of evidence that advanced glycation end products (AGE) and their receptor (RAGE) system are implicated in chronic kidney disease (CKD). We have previously found that a long-acting calcium channel blocker, azelnidipine, but not amlodipine, improves renal injury in CKD patients. However...
journal_title:Clinical cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1002/clc.20885
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:Advanced practice providers (APPs) can fill care gaps created by physician shortages and improve adherence/compliance with preventive ASCVD interventions. HYPOTHESIS:APPs utilizing guideline-based algorithms will more frequently escalate ASCVD risk factor therapies. METHODS:We retrospectively reviewed data...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.22963
更新日期:2018-06-01 00:00:00
abstract::The prevalence of interatrial block (IAB) is high in the elderly, particularly in those with heart disease. Despite this high prevalence-and the association of IAB with the risk of atrial fibrillation (AF), stroke, and cognitive decline-little information exists about the prognosis of older patients with IAB. P-wave d...
journal_title:Clinical cardiology
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1002/clc.22647
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Intravenous inotropic intervention in congestive heart failure is generally associated with a poor prognosis and is largely used as a "bridge" to mechanical support or heart transplantation. HYPOTHESIS:We hypothesized that the inotropic support afforded by dobutamine may serve as a bridge to the introductio...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960240311
更新日期:2001-03-01 00:00:00
abstract::A 62-year-old man was admitted to our hospital with unstable angina. The coronary arteriography showed the occlusion of the left anterior descending artery and other stenotic lesions. The patient underwent an aortocoronary bypass operation, but unfortunately he did not survive. Surprisingly, the necropsy revealed him ...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960091113
更新日期:1986-11-01 00:00:00
abstract:BACKGROUND:Syncope is a common clinical problem with a variety of underlying mechanisms, some of which occur more frequently in 1 of the sexes or at a certain age. HYPOTHESIS:There may be clinically significant age- and gender-related differences in patients with unexplained syncope. METHODS:Five hundred seventy pati...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.22300
更新日期:2014-10-01 00:00:00
abstract::The safety of quinapril hydrochloride, a new nonsulfhydryl angiotensin-converting enzyme (ACE) inhibitor with an intermediate duration of action, has been evaluated in 3,031 patients with hypertension and congestive heart failure (CHF) and has been compared with other ACE inhibitors. A comparison of double-blind studi...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960131408
更新日期:1990-06-01 00:00:00
abstract::Cardiac troponins (CTn) are the most sensitive and specific biochemical markers of myocardial injury and risk stratification. The assay for troponin T (cTnI) is standardized, and results obtained from different institutions are comparable. This is not the case with troponin I (cTnT), and clinicians should be aware tha...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.20445
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Conventional approaches to management of congestive heart failure (CHF) rely on drugs that increase myocardial contractility or reduce ventricular afterload. These approaches often improve cardiac symptoms and survival, but may be associated with significant deleterious effects. An alternative approach is to...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960211206
更新日期:1998-12-01 00:00:00
abstract::Lipoprotein(a) [Lp(a)] is independently associated with atherosclerotic cardiovascular disease and calcific aortic valve stenosis. Elevated Lp(a) affects approximately one in five individuals and meaningfully contributes to the residual cardiovascular risk in individuals with otherwise well-controlled risk factors. Wi...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.23456
更新日期:2020-11-01 00:00:00
abstract::Cardiac rehabilitation (CR) is an important component in the continuum of care for patients with cardiovascular diseases, including the older population. Benefits of CR which include mortality benefit, decreased hospitalizations, increased functional capacity all extend to an older population. In Medicare beneficiarie...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.23296
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Late potentials (LP) on signal-averaged electrocardiography (SAECG), recorded 6 to 30 days after an acute myocardial infarction (AMI), identify patients at risk for late arrhythmic events. Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce ventricular remodeling and cardiovascular morta...
journal_title:Clinical cardiology
pub_type: 临床试验,杂志文章
doi:10.1002/clc.4960230206
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:Assessment of patients with aortic stenosis (AS) and impaired left ventricular function remains challenging. Aortic valve calcium (AVC) scoring with computed tomography (CT) and fluoroscopy has been proposed as means of diagnosing and predicting outcomes in patients with severe AS. HYPOTHESIS:Severity of ao...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.22212
更新日期:2014-01-01 00:00:00
abstract::To determine the accuracy of two-dimensional echocardiography (2-D echo) for assessment of exercise-induced wall motion abnormalities in patients with coronary artery disease, the results of stress echocardiography were compared with exercise cineventriculography. In 56 consecutive patients, biplane cineventriculograp...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960110808
更新日期:1988-08-01 00:00:00
abstract::Cusp entrapment is a previously unreported mechanism of aortic insufficiency after balloon aortic valvuloplasty. In a patient who developed severe acute aortic insufficiency and expired after balloon aortic valvuloplasty, pathologic evaluation revealed a large, solitary, fractured, calcific nodule in the noncoronary c...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.4960120711
更新日期:1989-07-01 00:00:00
abstract::Rapid assessment of patients presenting with acute chest pain is essential, in order to distinguish between those who have a life-threatening condition, such as myocardial infarction or unstable angina, and the substantial proportion who do not have an acute coronary syndrome. It is thus of vital importance that relia...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.4960231306
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a multidetector computed tomography (MDCT) imaging technique as an adjuvant to coronary angiography (CAG) is eminent. The purpose of this study was to d...
journal_title:Clinical cardiology
pub_type: 杂志文章,评审
doi:10.1002/clc.22297
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Sex-based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. HYPOTHESIS:Age is a modifier of temporal trends in sex-based differences in ACS care. METHODS:Among 104 817 eligible patients with ACS enrolled in the AHA Get With the ...
journal_title:Clinical cardiology
pub_type: 杂志文章,多中心研究
doi:10.1002/clc.22938
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Exercise-based rehabilitation is an important part of treatment patients following coronary artery bypass graft (CABG) surgery. HYPOTHESIS:To evaluate effect of very short/short-term exercise training on cardiopulmonary exercise testing (CPET) parameters. METHODS:We studied 54 consecutive patients with myo...
journal_title:Clinical cardiology
pub_type: 杂志文章
doi:10.1002/clc.22656
更新日期:2017-05-01 00:00:00