Vnitr Lek 2023, 69(8):510-515 | DOI: 10.36290/vnl.2023.102

Heart failure with mildly reduced ejection fraction - updates in pharmacotherapy

Alzběta Trčková, Lenka Špinarová
I. interní kardioangiologická klinika Fakultní nemocnice u svaté Anny v Brně, Lékařská fakulta Masarykovy univerzity, Brno

This review targets at patients suffering from heart failure with mildly reduced ejection fraction (HFmrEF). Diagnostic is briefly mentioned whereas pharmacotherapy is discused more due to significant changes in guidelines. New to therapy are gliflosins with AI recommendation. Also other therapy, such as angiotensin receptor blockers, beta blockers, mineralocorticoid blockers and diuretics are discussed below. Vericiguat and iron supplement therapy is described to complete the pharmacotherapeutic portfolio.

Keywords: echocardiography, pharmacotherapy, gliflozins, heart failure with mildly reduced ejection fraction (HFmrEF).

Accepted: November 27, 2023; Published: December 18, 2023  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Trčková A, Špinarová L. Heart failure with mildly reduced ejection fraction - updates in pharmacotherapy. Vnitr Lek. 2023;69(8):510-515. doi: 10.36290/vnl.2023.102.
Download citation

References

  1. Melenovský V, et al. Srdeční selhání pro klinickou praxi. 2. vydání. Grada: Praha 2023: 685-691 ISBN 978-80-271-3732-9.
  2. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Accessed September 17, 2023.
  3. Savarese G, Stolfo D, Sinagra G, Lund LH. Heart failure with mid­‑range or mildly reduced ejection fraction. Nat Rev Cardiol. 2022;19(2):100-116. Go to original source... Go to PubMed...
  4. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129-2200. Go to original source... Go to PubMed...
  5. Táborský M, Skála T, Lazárová M, et al. Trends in the treatment and survival of heart failure patients: a nationwide population based study in the Czech Republic. ESC Heart Fail. 2021;8(5):3800-3808. Go to original source... Go to PubMed...
  6. Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left­‑ventricular ejection fraction: the CHARM­‑Preserved Trial. The Lancet. 2003;362(9386):777-781. Go to original source... Go to PubMed...
  7. Talha KM, Butler J. Breakthroughs in the treatment of heart failure with mildly reduced and preserved ejection fraction. Clinical Cardiology. 2022;45(S1):S31-S39. Go to original source... Go to PubMed...
  8. Butler J, Anker SD, Packer M. Redefining Heart Failure With a Reduced Ejection Fraction. JAMA. 2019;322(18):1761-1762. Go to original source... Go to PubMed...
  9. Peters AE, Clare RM, Chiswell K, et al. Echocardiographic Features Beyond Ejection Fraction and Associated Outcomes in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction. Circulation: Heart Failure. 2023;16(5):e010252. Go to original source... Go to PubMed...
  10. Lopatin Y. Heart Failure with Mid­‑Range Ejection Fraction and How to Treat It. Card Fail Rev. 2018;4(1):9-13.
  11. Táborský M, et al. Kardiologie - IV. Srdeční selhání. 1. vydání. Grada: Praha 2021: 1-4, 20-29, 327-339 ISBN 978-80-271-1439-9.
  12. Cleland JGF, Tendera M, Adamus J, et al. The perindopril in elderly people with chronic heart failure (PEP­‑CHF) study. Eur Heart J. 2006;27(19):2338-2345. Go to original source... Go to PubMed...
  13. Solomon SD, Zile M, Pieske B, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double­‑blind randomised controlled trial. The Lancet. 2012;380(9851):1387-1395. Go to original source... Go to PubMed...
  14. Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. New England Journal of Medicine. 2019;381(17):1609-1620. Go to original source... Go to PubMed...
  15. Mentz RJ, Ward JH, Hernandez AF, et al. Angiotensin­‑Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure. Journal of the American College of Cardiology. 2023;82(1):1-12. Go to original source... Go to PubMed...
  16. Vaduganathan M, Mentz RJ, Claggett BL, et al. Sacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre­‑specified participant­‑level pooled analysis of PARAGLIDE­‑HF and PARAGON­‑HF. European Heart Journal. 2023;44(31):2982-2993. Go to original source... Go to PubMed...
  17. Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for Heart Failure with Preserved Ejection Fraction. New England Journal of Medicine. 2014;370(15):1383-1392. Go to original source... Go to PubMed...
  18. Komajda M, Isnard R, Cohen­‑Solal A, et al. Effect of ivabradine in patients with heart failure with preserved ejection fraction: the EDIFY randomized placebo­‑controlled trial. European Journal of Heart Failure. 2017;19(11):1495-1503. Go to original source... Go to PubMed...
  19. Komajda M, Isnard R, Cohen­‑Solal A, et al. Effect of ivabradine in patients with heart failure with preserved ejection fraction: the EDIFY randomized placebo­‑controlled trial. European Journal of Heart Failure. 2017;19(11):1495-1503. Go to original source... Go to PubMed...
  20. Armstrong PW, Lam CSP, Anstrom KJ, et al. Effect of Vericiguat vs Placebo on Quality of Life in Patients With Heart Failure and Preserved Ejection Fraction: The VITALITY­‑HFpEF Randomized Clinical Trial. JAMA. 2020;324(15):1512-1521. Go to original source... Go to PubMed...
  21. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. New England Journal of Medicine. 2021;385(16):1451-1461. Go to original source... Go to PubMed...
  22. Voors AA, Angermann CE, Teerlink JR, et al. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial. Nat Med. 2022;28(3):568-574. Go to original source... Go to PubMed...
  23. Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. New England Journal of Medicine. 2022;387(12):1089-1098. Go to original source... Go to PubMed...
  24. Chatur S, Vaduganathan M, Claggett B, et al. Dapagliflozin and diuretic utilization in heart failure with mildly reduced or preserved ejection fraction: the DELIVER trial. European Heart Journal. 2023;44(31):2930-2943. Go to original source... Go to PubMed...
  25. Kalra PR, Cleland JGF, Petrie MC, et al. Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator­‑initiated, prospective, randomised, open­‑label, blinded­‑endpoint trial. The Lancet. 2022;400(10369):2199-2209. Go to original source... Go to PubMed...
  26. Ponikowski P, Kirwan BA, Anker SD, et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double­‑blind, randomised, controlled trial. Lancet. 2020;396(10266):1895-1904. Go to original source... Go to PubMed...
  27. Moss AJ, Hall WJ, Cannom DS, et al. Cardiac­‑Resynchronization Therapy for the Prevention of Heart­‑Failure Events. New England Journal of Medicine. 2009;361(14):1329-1338. Go to original source... Go to PubMed...
  28. Tang ASL, Wells GA, Talajic M, et al. Cardiac­‑Resynchronization Therapy for Mild­‑to­‑Moderate Heart Failure. New England Journal of Medicine. 2010;363(25):2385-2395. Go to original source... Go to PubMed...
  29. Vijayaraman P, Pokharel P, Subzposh FA, et al. His­‑Purkinje Conduction System Pacing Optimized Trial of Cardiac Resynchronization Therapy (HOT­‑CRT) versus Biventricular Pacing. JACC: Clinical Electrophysiology. 0(0).
  30. Vijayaraman P, Sharma PS, Cano Ó, et al. LB-456088-1 Left bundle brunch area pacing compared to biventricular pacing for cardiac resynchronization therapy: results from international LBBAP collaborative study group. Heart Rhythm. 2023;20(7):1094-1095. Go to original source...
  31. Rao IV, Burkhoff D. Cardiac contractility modulation for the treatment of moderate to severe HF.Expert Review of Medical Devices. 2021;18(1):15-21. Go to original source... Go to PubMed...
  32. Abraham WT, Kuck KH, Goldsmith RL, et al. A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation. JACC: Heart Failure. 2018;6(10):874-883. Go to original source... Go to PubMed...
  33. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Accessed September 17, 2023.




Vnitřní lékařství

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.