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Review Article
Obesity and heart failure with preserved ejection fraction: pathophysiology and clinical significance
Da Young Lee
Cardiovasc Prev Pharmacother. 2022;4(2):70-74.   Published online April 27, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e10
  • 2,107 View
  • 63 Download
Abstract PDF
Obesity is a risk factor for heart failure and cardiovascular disease. Of particular note, over 80% of patients with heart failure with a preserved ejection fraction (HFpEF) are overweight or obese. In this study, we aimed to review the association between obesity and HFpEF. Obese patients with HFpEF exhibit a distinct phenotype. In addition to impaired left ventricular (LV) diastolic function and high filling pressures, obese patients with HFpEF possess other factors that cause elevated LV filling pressure, such as a greater dependence on plasma volume expansion, aggravated pericardial restraint, and increased ventricular interaction. Obesity can contribute to HFpEF through hemodynamic, neurohormonal, inflammatory, and mechanical mechanisms. An increased amount of body fat can induce plasma volume expansion, resulting in chamber remodeling, pericardial restraint, and ultimately elevations in LV filling pressure. Obesity can mediate the activation of sympathetic nervous system signaling and the renin-angiotensin-aldosterone system. These unique pathophysiological characteristics of individuals with both obesity and HFpEF suggest that obesity with HFpEF can be considered a specific phenotype. Future research is expected to clarify effective treatment modalities for obesity-related HFpEF.
Special Articles
Diabetes and Heart Failure
Eun-Jung Rhee
Cardiovasc Prev Pharmacother. 2021;3(2):21-30.   Published online April 30, 2021
DOI: https://doi.org/10.36011/cpp.2021.3.e4
  • 2,791 View
  • 61 Download
Abstract PDF
Heart failure (HF) in patients with diabetes mellitus has long been considered a consequence of coronary artery disease (CAD). However, recent epidemiological evidence on patients with diabetes showed a significantly increased prevalence of HF in patients with no significant stenosis in the coronary artery. As such, these are thought to be separate entities of diabetic complications. Therefore, HF in patients with diabetes is now considered an independent disease entity of the ‘diabetic heart.’ The mechanism of ‘diabetic heart’ could be due to CAD and diabetic cardiomyopathy caused by altered energy metabolism in the myocardium and advanced glycation end-product accumulation, altered calcium handling, and oxidative stress in the myocardium. Recent cardiovascular outcome trials of anti-diabetic medications have shown the protective effects of certain drugs against HF in patients with and without diabetes. In this review, the relationship between diabetes and the treatment and prevention of HF is summarized.
Vasopressin Receptor Antagonist, Tolvaptan, for Treating Hyponatremia in Patients with Heart Failure
Kyung-Jin Kim
Cardiovasc Prev Pharmacother. 2021;3(1):10-14.   Published online January 31, 2021
DOI: https://doi.org/10.36011/cpp.2021.3.e3
  • 2,954 View
  • 76 Download
  • 1 Citations
Abstract PDF
Hyponatremia is common in hospital setting in patients with heart failure and is associated with increased morbidity and mortality. However, despite these complications, appropriate treatment strategies other than established therapies such as hypertonic saline, loop diuretics, and fluid restriction are limited. Tolvaptan, a vasopressin receptor antagonist, has aquaretic effects that excrete free water and dilutes urine, thereby increasing serum sodium concentration. This new approach might be a landmark in the treatment of hyponatremia as there is a lack of controlled studies in this field. However, regardless of the associated advantage, tolvaptan is recommended to be used for less than 30 days owing to the possibility of liver injury. This study is aimed to present the clinical use of tolvaptan for hyponatremia in patients with heart failure.

Citations

Citations to this article as recorded by  
  • The role of tolvaptan add-on therapy in patients with acute heart failure: a systematic review and network meta-analysis
    Vireza Pratama, Jordan Budiono, Jarir At Thobari, Bambang Widyantoro, Vita Yanti Anggraeni, Lucia Kris Dinarti
    Frontiers in Cardiovascular Medicine.2024;[Epub]     CrossRef
Update on the Pharmacotherapy of Heart Failure with Reduced Ejection Fraction
Eui-Soon Kim, Jong-Chan Youn, Sang Hong Baek
Cardiovasc Prev Pharmacother. 2020;2(4):113-133.   Published online October 31, 2020
DOI: https://doi.org/10.36011/cpp.2020.2.e17
  • 8,495 View
  • 129 Download
  • 12 Citations
Abstract PDF
Heart failure (HF) is an important cardiovascular disease because of the increasing prevalence, high morbidity and mortality, and rapid expansion of health care costs. Over the past decades, efforts have been made to modify the prognosis of patients with HF. Regarding HF with reduced ejection fraction (HFrEF), several drugs have shown to improve mortality and morbidity, based on large-scale randomized controlled trials, leading to a critical paradigm shift in its pharmacological treatment. The paradigm of HFrEF pathophysiology has shifted from cardiorenal disease to hemodynamic changes, and neurohormonal activation is currently considered the prime pathophysiological mechanism of HFrEF. This review summarizes evidence on the pharmacological management of HFrEF derived from major randomized controlled trials, which have accomplished improvements in survival benefits.

Citations

Citations to this article as recorded by  
  • Real-World Eligibility and Cost-Effectiveness Analysis of Empagliflozin for Heart Failure in Korea
    Eui-Soon Kim, Sun-Kyeong Park, Jong-Chan Youn, Hye Sun Lee, Hae-Young Lee, Hyun-Jai Cho, Jin-Oh Choi, Eun-Seok Jeon, Sang Eun Lee, Min-Seok Kim, Jae-Joong Kim, Kyung-Kuk Hwang, Myeong-Chan Cho, Shung Chull Chae, Seok-Min Kang, Jin Joo Park, Dong-Ju Choi,
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Eligibility and Cost-Utility Analysis of Dapagliflozin in Patients with Heart Failure Across the Whole Spectrum of Ejection Fraction in South Korea
    Eui-Soon Kim, Sun-Kyeong Park, Daniel Sung-ho Cho, Jong-Chan Youn, Hye Sun Lee, Hae-Young Lee, Hyun-Jai Cho, Jin-Oh Choi, Eun-Seok Jeon, Sang Eun Lee, Min-Seok Kim, Jae-Joong Kim, Kyung-Kuk Hwang, Myeong-Chan Cho, Shung Chull Chae, Seok-Min Kang, Jin Joo
    American Journal of Cardiovascular Drugs.2024; 24(2): 313.     CrossRef
  • Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment
    Jong-Chan Youn, Darae Kim, Jae Yeong Cho, Dong-Hyuk Cho, Sang Min Park, Mi-Hyang Jung, Junho Hyun, Hyun-Jai Cho, Seong-Mi Park, Jin-Oh Choi, Wook-Jin Chung, Byung-Su Yoo, Seok-Min Kang
    Korean Circulation Journal.2023; 53(4): 217.     CrossRef
  • Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment
    Jong-Chan Youn, Darae Kim, Jae Yeong Cho, Dong-Hyuk Cho, Sang Min Park, Mi-Hyang Jung, Junho Hyun, Hyun-Jai Cho, Seong-Mi Park, Jin-Oh Choi, Wook-Jin Chung, Byung-Su Yoo, Seok-Min Kang
    International Journal of Heart Failure.2023; 5(2): 66.     CrossRef
  • Post-transplantation outcomes of sensitized patients receiving durable mechanical circulatory support
    Jong-Chan Youn, Xiaohai Zhang, Keith Nishihara, In-Cheol Kim, Sang Hong Baek, Osamu Seguchi, Evan P. Kransdorf, David H. Chang, Michelle M. Kittleson, Jignesh K. Patel, Robert M. Cole, Jaime D. Moriguchi, Danny Ramzy, Fardad Esmailian, Jon A. Kobashigawa
    The Journal of Heart and Lung Transplantation.2022; 41(3): 365.     CrossRef
  • Treatment of heart failure with a preserved ejection fraction
    Yuran Ahn, Jong-Chan Youn
    Journal of the Korean Medical Association.2022; 65(1): 18.     CrossRef
  • Multimodal Imaging and Biomarkers in Cardiac Amyloidosis
    Mi-Hyang Jung, Suyon Chang, Eun Ji Han, Jong-Chan Youn
    Diagnostics.2022; 12(3): 627.     CrossRef
  • Physician adherence and patient-reported outcomes in heart failure with reduced ejection fraction in the era of angiotensin receptor-neprilysin inhibitor therapy
    In-Cheol Kim, Jong-Chan Youn, Se Yong Jang, Sang Eun Lee, Hyun-Jai Cho, Jin-Oh Choi, Ju-Hee Lee, Kyung-Hee Kim, Sun Hwa Lee, Kye Hun Kim, Jong Min Lee, Byung-Su Yoo, Byung-Su Yoo, Se Yong Jang, Jong Min Lee, In-Cheol Kim, Jin-Oh Choi, Hyun-Jai Cho, Sang E
    Scientific Reports.2022;[Epub]     CrossRef
  • A dose–response relationship of renin–angiotensin system blockers and beta-blockers in patients with acute heart failure syndrome: a nationwide prospective cohort study
    Kyung An Kim, Eui-Soon Kim, Jong-Chan Youn, Hye Sun Lee, Soyoung Jeon, Hae-Young Lee, Hyun-Jai Cho, Jin-Oh Choi, Eun-Seok Jeon, Sang Eun Lee, Min-Seok Kim, Jae-Joong Kim, Kyung-Kuk Hwang, Myeong-Chan Cho, Shung Chull Chae, Seok-Min Kang, Dong-Ju Choi, Byu
    European Heart Journal - Cardiovascular Pharmacotherapy.2022; 8(6): 587.     CrossRef
  • Characteristics, outcomes, and predictors of de novo malignancy after heart transplantation
    Jong-Chan Youn, Darae Kim, In-Cheol Kim, Hye Sun Lee, Jin-Oh Choi, Eun-Seok Jeon, Keith Nishihara, Evan P. Kransdorf, David H. Chang, Michelle M. Kittleson, Jignesh K. Patel, Danny Ramzy, Fardad Esmailian, Jon A. Kobashigawa
    Frontiers in Cardiovascular Medicine.2022;[Epub]     CrossRef
  • Pathophysiology of Heart Failure with Preserved Ejection Fraction
    Jong-Chan Youn, Yuran Ahn, Hae Ok Jung
    Heart Failure Clinics.2021; 17(3): 327.     CrossRef
  • Heart failure risk in younger adults needing more attention
    Jong-Chan Youn, Sang Hong Baek
    International Journal of Cardiology.2021; 344: 135.     CrossRef
Original Article
CHA2DS2-VASc Score Is Correlated with Cardiac Performance in Chronic Atrial Fibrillation
Doo Soo Jeon, Mi-Jeong Kim, Wonjik Lee, Dongjae Lee, Ik Jun Choi
Cardiovasc Prev Pharmacother. 2020;2(2):56-62.   Published online April 30, 2020
DOI: https://doi.org/10.36011/cpp.2020.2.e9
  • 2,108 View
  • 15 Download
Abstract PDF
Background
The CHA2DS2-VASc score is a popular tool for risk prediction of thromboembolism in patients with atrial fibrillation (AF). Each component of the CHA2DS2-VASc scheme is an established risk factor for left ventricular diastolic dysfunction and heart failure (HF). In AF patients, HF is often adversely affecting to clinical outcomes including thromboembolism. We hypothesized that the CHA2DS2-VASc score reflects cardiac reserve and the risk of HF as well as the risk of stroke in patients with AF.
Methods
A total of 103 patients who had the diagnosis of chronic non-valvular AF patients with preserved ejection fraction (EF) were enrolled consecutively. CHA2DS2-VASc score was compared to exercise capacity (peak oxygen uptake, peak VO2), B-type natriuretic peptide (BNP) and echocardiographic diastolic dysfunction index (early mitral to annular velocity, E/E′) ratio.
Results
Exercise capacity was correlated with age (β=−0.568, p<0.001), CHA2DS2-VASc score (β=−0.526, p<0.001), BNP (β=−0.449, p<0.001) and diastolic dysfunction (β=−0.534, p<0.001). Patients with CHA2DS2-VASc score ≥2 had a significantly less exercise capacity than those with CHA2DS2-VASc score <2 (p<0.001). Higher CHA2DS2-VASc score was associated with lower exercise capacity, more diastolic dysfunction and higher BNP (for trend p=0.001).
Conclusions
High CHA2DS2-VASc score is associated with poor exercise capacity in patients with AF. Diastolic dysfunction is thought to be the major mechanism of exercise limitation. CHA2DS2-VASc score might be useful for predicting overall cardiac reserve as well as stroke risk stratification in AF patients.

CPP : Cardiovascular Prevention and Pharmacotherapy