Congestive heart failure Treatment of Heart failure with preserved ejection fraction: Difference between revisions
(Created page with "__NOTOC__ {{Congestive heart failure}} {{CMG}};{{AE}}{{MehdiP}} ==Overview== Treatment of HFpEF is focused on treating underlying disease, such as hypertension, Coronary...") |
No edit summary |
||
Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
Treatment of HFpEF is focused on treating underlying disease, such as [[hypertension]], [[Coronary heart disease|coronary artery disease]] and [[atrial fibrillation]]. [[Diuretics]] are the mainstay of [[pharmacotherapy]]. Other effective measures to control HFpEF include exercise, [[weight]] control and [[lipid]] control. | Treatment of HFpEF is focused on treating underlying disease, such as [[hypertension]], [[Coronary heart disease|coronary artery disease]] and [[atrial fibrillation]]. [[Diuretics]] are the mainstay of [[pharmacotherapy]]. Other effective measures to control HFpEF include exercise, [[weight]] control and [[lipid]] control. | ||
== | ==Overview== | ||
Treatment | Treatment of HFpEF is focused on treating underlying disease, such as [[hypertension]], [[Coronary heart disease|coronary artery disease]] and [[atrial fibrillation]]. [[Diuretics]] are the mainstay of [[pharmacotherapy]]. Other effective measures to control HFpEF include exercise, [[weight]] control and [[lipid]] control. | ||
== [[Heart failure mildly reduced ejection fraction]] ([[HPmrEF]]), [[EF]] (41-49%) == | |||
===[[ | ===The diagnosis of heart failure with [[mildly reduced ejection fraction]]=== | ||
*The diagnosis of [[HFmrEF]] requires the presence of [[symptoms]] and/or [[signs]] of [[HF]], and a mildly reduced [[EF]] (41-49%) The presence of elevated NPs ([[BNP]] ≥35 pg/mL or [[NT-proBNP]] ≥125 pg/mL) and other evidence of [[structural heart disease]] including increased [[left atrial]] ([[LA]]) size, [[LVH]] or [[echocardiographic]] measures of [[LV filling]].<ref name="pmid28370829">{{cite journal |vauthors=Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T, Abe R, Oikawa T, Kasahara S, Sato M, Shiroto T, Takahashi J, Miyata S, Shimokawa H |title=Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study |journal=Eur J Heart Fail |volume=19 |issue=10 |pages=1258–1269 |date=October 2017 |pmid=28370829 |doi=10.1002/ejhf.807 |url=}}</ref> | |||
===[[ | ===Clinical characteristics === | ||
*[[Clinical]] characteristics, [[risk factors]], patterns of [[cardiac remodelling]] are similar to other subgroups of [[HF]]. | |||
* [[HFmrEF]] is more common in [[men]], [[younger]], and are more likely to have [[CAD]] (50-60%) and less likely to have [[AF]] and non-cardiac [[comorbidities]]. ambulatory | |||
[[ | *[[HFmrEF]] have lower mortality rate than those with [[HFrEF]]. | ||
===Treatment=== | |||
=== Angiotensin-converting enzyme inhibitors=== | |||
*[[ACE-I]] may be considered in [[patients]] with HFmrEF and underlying [[CAD]], [[hypertension]], or post-[[MI]] [[LV systolic dysfunction]]. | |||
===[[ | ===[[Angiotensin receptor II type 1 receptor blockers]]=== | ||
*[[Candesartan]] reduced the number of [[patients]] hospitalized for [[HF]] among those with [[HFmrEF]].<ref name="pmid13678871">{{cite journal |vauthors=Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J |title=Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial |journal=Lancet |volume=362 |issue=9386 |pages=777–81 |date=September 2003 |pmid=13678871 |doi=10.1016/S0140-6736(03)14285-7 |url=}}</ref> | |||
*Treatment with [[ARBs]] may be considered in [[patients]] with [[HFmrEF]] [[patients]] with other [[cardiovascular]] indications. | |||
===[[ | ===[[Beta-blockers]]=== | ||
[[ | * Treatment with [[beta-blockers]] may be considered in [[patients]] with [[HFmrEF]] and another [[cardiovascular]] indications, such as [[AF]] or [[angina]].<ref name="pmid15642700">{{cite journal |vauthors=Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker SD, Thompson SG, Poole-Wilson PA |title=Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS) |journal=Eur Heart J |volume=26 |issue=3 |pages=215–25 |date=February 2005 |pmid=15642700 |doi=10.1093/eurheartj/ehi115 |url=}}</ref> | ||
== | ===[[ Mineralocorticoid receptor antagonists]]=== | ||
* In a retrospective analysis of the [[TOPCAT]] trial in [[patients]] with [[LVEF]] ≥45%, [[spironolactone]] reduced hospitalizations for [[HF]] in [[patients]] with an [[LVEF]] <55%. | |||
* Treatment with an [[MRA]] may be considered in [[patients]] with [[HFmrEF]]. | |||
===[[Angiotensin receptor-neprilysin inhibitor]]=== | |||
*Analysis of the [[PARADIGM-HF]] and [[PARAGON-HF]] trials showed that [[sacubitril/valsartan]], compared to other forms of [[RAAS]] blockade reduced [[hospitalizations]] in [[patients]] with [[HFmrEF]]. | |||
=== Other drugs=== | |||
*In the [[DIG trial]], use of [[digoxin]] for [[patients]] with [[HFmrEF]] in [[sinus rhythm]] was associated with fewer hospitalizations but no reduction in mortality and a trend to increase of [[cardiovascular]] deaths. | |||
*Therefore, there are insufficient data to recommend its use. | |||
*There are insufficient data on [[ivabradine]] in [[HFmrEF]]. | |||
=== Devices=== | |||
*There is insufficient evidence regarding [[CRT]] or [[ICD]] therapy in [[patients]] with [[HFmrEF]]. | |||
{| | ===Medications indicated in [[patients]] with [[New York Heart Association]] ([[NYHA]] class II–IV) [[HFmrEF]] ([[heart failure]] with mildly reduced [[ejection fraction]]) ([[LVEF]]41-49%)=== | ||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |- | ||
| | | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommedation for patients with NYHA class 2-4 heart failure with mildly reduced ejection fraction | ||
|- | |- | ||
| | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' [[Diuretics]] ([[ESC guidelines classification scheme|Class I, Level of Evidence C]]):''' | ||
|- | |- | ||
| | |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | ||
❑ [[Diuretics]] are recommended in [[patients]] with [[congestion]] and [[HFmrEF]] in order reduce [[symptoms]] and [[signs]]<br> | |||
|- | |- | ||
| | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' [[ACEI]] ([[ESC guidelines classification scheme|Class IIb, Level of Evidence C]]):''' | ||
|- | |- | ||
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | |||
❑ [[ACE-I]] may be considered for patients with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death<br> | |||
❑ [[ARB]] may be indicated for [[patients]] with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death<br> | |||
❑ [[Beta-blocker]] may be considered for [[patients]] with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death,<br> | |||
❑ [[MRA]] may be considered for patients with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death<br> | |||
❑[[Sacubitril/valsartan]] may be considered for [[patients]] with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death<br> | |||
|} | |} | ||
{| | {| | ||
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2021 ESC Guideline | |||
|- | |||
|}<ref name="pmid34447992">{{cite journal |vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A |title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure |journal=Eur Heart J |volume=42 |issue=36 |pages=3599–3726 |date=September 2021 |pmid=34447992 |doi=10.1093/eurheartj/ehab368 |url=}}</ref> | |||
==[[Heart failure preserved ejection fraction]] ([[HFpEF]])== | |||
* | |||
===Clinical characteristics=== | |||
* [[HFpEF]] [[patients]] are [[older]] and more often [[female]]. | |||
* [[AF]], [[CKD]], and non-[[cardiovascular]] comorbidities are more common in [[patients]] with [[HFpEF]].<ref name="pmid32231333">{{cite journal |vauthors=Borlaug BA |title=Evaluation and management of heart failure with preserved ejection fraction |journal=Nat Rev Cardiol |volume=17 |issue=9 |pages=559–573 |date=September 2020 |pmid=32231333 |doi=10.1038/s41569-020-0363-2 |url=}}</ref> | |||
* It is important to exclude other [[conditions]] that might mimic the [[HFpEF]] syndrome including [[lung]] disease, [[anaemia]], [[obesity]], and [[deconditioning]]. | |||
=== The diagnosis of [[heart failure preserved ejection fraction]]=== | |||
*: Echocardiographic criteria: | |||
*[[ LA]] size ([[LA]] volume index >32 mL/m2) | |||
* [[Mitral]] E velocity <90 cm/s | |||
* Septal e' velocity <9 cm/s | |||
* E/e' ratio >9 | |||
*: The diagnosis is made when there are the following: | |||
(1) [[Symptoms]] and signs of [[HF]]<br> | |||
(2) An [[LVEF]] ≥ 50%<br> | |||
(3) Evidence of [[cardiac]] structural and/or functional abnormalities consistent with the presence of [[LV diastolic dysfunction]]/ raised [[LV filling pressures]], including raised [[NPs]]<br> | |||
*In the presence of [[AF]], the threshold for [[LA]] volume index is >40 mL/m2 | |||
* [[Exercise stress]] thresholds include E/e' ratio at peak stress ≥ 15 or [[tricuspid regurgitation]] ([[TR]]) velocity at peak stress >3.4 m/s | |||
* [[LV]] global longitudinal strain <16% | |||
*An invasively measured [[pulmonary capillary wedge pressure]] ([[PCWP]]) of ≥15 mmHg (at rest) or ≥25 mmHg (with exercise) or [[LV end-diastolic pressure ]]≥16 mmHg (at rest) is generally considered diagnostic.<ref name="pmid31472035">{{cite journal |vauthors=Barandiarán Aizpurua A, Sanders-van Wijk S, Brunner-La Rocca HP, Henkens M, Heymans S, Beussink-Nelson L, Shah SJ, van Empel VPM |title=Validation of the HFA-PEFF score for the diagnosis of heart failure with preserved ejection fraction |journal=Eur J Heart Fail |volume=22 |issue=3 |pages=413–421 |date=March 2020 |pmid=31472035 |doi=10.1002/ejhf.1614 |url=}}</ref> | |||
*In the presence of non-invasive markers of raised [[LV filling pressures]], the probability of a diagnosis of [[HFpEF]] increases.<ref name="pmid31132875">{{cite journal |vauthors=Ho JE, Zern EK, Wooster L, Bailey CS, Cunningham T, Eisman AS, Hardin KM, Zampierollo GA, Jarolim P, Pappagianopoulos PP, Malhotra R, Nayor M, Lewis GD |title=Differential Clinical Profiles, Exercise Responses, and Outcomes Associated With Existing HFpEF Definitions |journal=Circulation |volume=140 |issue=5 |pages=353–365 |date=July 2019 |pmid=31132875 |doi=10.1161/CIRCULATIONAHA.118.039136 |url=}}</ref> | |||
* No treatment has been shown to reduce [[mortality]] and [[morbidity]] in [[patients]] with [[HFpEF]]. | |||
*Hospitalizations for [[HF]] were reduced by [[candesartan]] and [[spironolactone]], [[sacubitril/valsartan]]. | |||
* Many of [[HFpEF]] [[patients]] have underlying [[hypertension]] and/or [[CAD]], treated with [[ACE-I]]/[[ARB]], [[beta-blockers]], or [[MRAs]]. | |||
* The [[Food and Drug Administration]] ([[FDA]]) has confirmed the use of [[sacubitril/valsartan]] and [[spironolactone ]] in those with an [[LVEF]] ‘less than normal’. | |||
* These statements relate to [[patients]] within both the [[HFmrEF]] and [[HFpEF]] categories. | |||
*For sacubitril/valsartan, subgroup analysis from the [[PARAGON-HF]] study showed a reduction in [[HF]] hospitalizations in [[patients]] with [[LVEF]] <57%, and a meta-analysis of the [[PARADIGM-HF]] and [[PARAGON-HF]] studies showed a reduction in [[cardiovascular]] death and [[HF]] hospitalization in [[patients]] with [[ LVEF]] below the normal range. | |||
* Use of [[spironolactone]], in [[TOPCAT]] study was associated with reduced [[cardiovascular]] death and [[HF]] [[hospitalization]], | |||
*Treatment should be aimed at reducing [[symptoms]] of [[congestion]] with [[diuretics]] such as [[loop diuretic]]. | |||
* [[Thiazide]] [[diuretics]] may be useful for managing [[hypertension]]. | |||
* Reducing [[body weight]] in [[obese]] [[patients]] and increasing [[exercise]] may further improve symptoms and [[exercise capacity]]. | |||
* Notably in [[patients]] with [[HFpEF]], treatment of underlying risk factors, [[etiology]], and coexisting [[comorbidities]] such as [[hypertension]], [[CAD]], [[AF]], [[valvular heart disease]] are recommended. | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |- | ||
| | | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommedation for treatment of patients with [[HFpEF]] (heart failure preserved ejection fraction) | ||
|- | |- | ||
| | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''([[ESC guidelines classification scheme|Class I, Level of Evidence C]]):''' | ||
|- | |- | ||
| | |style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left| | ||
❑ Screening, treatment, investigation about underlying etiologies, and | |||
[[cardiovascular]] and non-[[cardiovascular]] comorbidities is recommended in [[patients]] with [[HFpEF]]<br> | |||
❑[[Diuretics]] are recommended in congested [[patients]] with [[HFpEF]] to improve [[symptoms]] and [[signs]] <br> | |||
|} | |} | ||
{| | |||
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2021 ESC Guideline | |||
|- | |||
|}<ref name="pmid34447992">{{cite journal |vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A |title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure |journal=Eur Heart J |volume=42 |issue=36 |pages=3599–3726 |date=September 2021 |pmid=34447992 |doi=10.1093/eurheartj/ehab368 |url=}}</ref> | |||
==References== | ==References== |
Revision as of 13:47, 2 March 2022
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Treatment of HFpEF is focused on treating underlying disease, such as hypertension, coronary artery disease and atrial fibrillation. Diuretics are the mainstay of pharmacotherapy. Other effective measures to control HFpEF include exercise, weight control and lipid control.
Overview
Treatment of HFpEF is focused on treating underlying disease, such as hypertension, coronary artery disease and atrial fibrillation. Diuretics are the mainstay of pharmacotherapy. Other effective measures to control HFpEF include exercise, weight control and lipid control.
Heart failure mildly reduced ejection fraction (HPmrEF), EF (41-49%)
The diagnosis of heart failure with mildly reduced ejection fraction
- The diagnosis of HFmrEF requires the presence of symptoms and/or signs of HF, and a mildly reduced EF (41-49%) The presence of elevated NPs (BNP ≥35 pg/mL or NT-proBNP ≥125 pg/mL) and other evidence of structural heart disease including increased left atrial (LA) size, LVH or echocardiographic measures of LV filling.[1]
Clinical characteristics
- Clinical characteristics, risk factors, patterns of cardiac remodelling are similar to other subgroups of HF.
- HFmrEF is more common in men, younger, and are more likely to have CAD (50-60%) and less likely to have AF and non-cardiac comorbidities. ambulatory
- HFmrEF have lower mortality rate than those with HFrEF.
Treatment
Angiotensin-converting enzyme inhibitors
- ACE-I may be considered in patients with HFmrEF and underlying CAD, hypertension, or post-MI LV systolic dysfunction.
Angiotensin receptor II type 1 receptor blockers
- Candesartan reduced the number of patients hospitalized for HF among those with HFmrEF.[2]
- Treatment with ARBs may be considered in patients with HFmrEF patients with other cardiovascular indications.
Beta-blockers
- Treatment with beta-blockers may be considered in patients with HFmrEF and another cardiovascular indications, such as AF or angina.[3]
Mineralocorticoid receptor antagonists
- In a retrospective analysis of the TOPCAT trial in patients with LVEF ≥45%, spironolactone reduced hospitalizations for HF in patients with an LVEF <55%.
- Treatment with an MRA may be considered in patients with HFmrEF.
Angiotensin receptor-neprilysin inhibitor
- Analysis of the PARADIGM-HF and PARAGON-HF trials showed that sacubitril/valsartan, compared to other forms of RAAS blockade reduced hospitalizations in patients with HFmrEF.
Other drugs
- In the DIG trial, use of digoxin for patients with HFmrEF in sinus rhythm was associated with fewer hospitalizations but no reduction in mortality and a trend to increase of cardiovascular deaths.
- Therefore, there are insufficient data to recommend its use.
- There are insufficient data on ivabradine in HFmrEF.
Devices
Medications indicated in patients with New York Heart Association (NYHA class II–IV) HFmrEF (heart failure with mildly reduced ejection fraction) (LVEF41-49%)
Recommedation for patients with NYHA class 2-4 heart failure with mildly reduced ejection fraction |
Diuretics (Class I, Level of Evidence C): |
❑ Diuretics are recommended in patients with congestion and HFmrEF in order reduce symptoms and signs |
ACEI (Class IIb, Level of Evidence C): |
❑ ACE-I may be considered for patients with HFmrEF to reduce the risk of HF hospitalization and death |
The above table adopted from 2021 ESC Guideline |
---|
Heart failure preserved ejection fraction (HFpEF)
Clinical characteristics
- HFpEF patients are older and more often female.
- AF, CKD, and non-cardiovascular comorbidities are more common in patients with HFpEF.[5]
- It is important to exclude other conditions that might mimic the HFpEF syndrome including lung disease, anaemia, obesity, and deconditioning.
The diagnosis of heart failure preserved ejection fraction
- Echocardiographic criteria:
- LA size (LA volume index >32 mL/m2)
- Mitral E velocity <90 cm/s
- Septal e' velocity <9 cm/s
- E/e' ratio >9
- The diagnosis is made when there are the following:
(1) Symptoms and signs of HF
(2) An LVEF ≥ 50%
(3) Evidence of cardiac structural and/or functional abnormalities consistent with the presence of LV diastolic dysfunction/ raised LV filling pressures, including raised NPs
- In the presence of AF, the threshold for LA volume index is >40 mL/m2
- Exercise stress thresholds include E/e' ratio at peak stress ≥ 15 or tricuspid regurgitation (TR) velocity at peak stress >3.4 m/s
- LV global longitudinal strain <16%
- An invasively measured pulmonary capillary wedge pressure (PCWP) of ≥15 mmHg (at rest) or ≥25 mmHg (with exercise) or LV end-diastolic pressure ≥16 mmHg (at rest) is generally considered diagnostic.[6]
- In the presence of non-invasive markers of raised LV filling pressures, the probability of a diagnosis of HFpEF increases.[7]
- No treatment has been shown to reduce mortality and morbidity in patients with HFpEF.
- Hospitalizations for HF were reduced by candesartan and spironolactone, sacubitril/valsartan.
- Many of HFpEF patients have underlying hypertension and/or CAD, treated with ACE-I/ARB, beta-blockers, or MRAs.
- The Food and Drug Administration (FDA) has confirmed the use of sacubitril/valsartan and spironolactone in those with an LVEF ‘less than normal’.
- These statements relate to patients within both the HFmrEF and HFpEF categories.
- For sacubitril/valsartan, subgroup analysis from the PARAGON-HF study showed a reduction in HF hospitalizations in patients with LVEF <57%, and a meta-analysis of the PARADIGM-HF and PARAGON-HF studies showed a reduction in cardiovascular death and HF hospitalization in patients with LVEF below the normal range.
- Use of spironolactone, in TOPCAT study was associated with reduced cardiovascular death and HF hospitalization,
- Treatment should be aimed at reducing symptoms of congestion with diuretics such as loop diuretic.
- Thiazide diuretics may be useful for managing hypertension.
- Reducing body weight in obese patients and increasing exercise may further improve symptoms and exercise capacity.
- Notably in patients with HFpEF, treatment of underlying risk factors, etiology, and coexisting comorbidities such as hypertension, CAD, AF, valvular heart disease are recommended.
Recommedation for treatment of patients with HFpEF (heart failure preserved ejection fraction) |
(Class I, Level of Evidence C): |
❑ Screening, treatment, investigation about underlying etiologies, and
cardiovascular and non-cardiovascular comorbidities is recommended in patients with HFpEF |
The above table adopted from 2021 ESC Guideline |
---|
References
- ↑ Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T, Abe R, Oikawa T, Kasahara S, Sato M, Shiroto T, Takahashi J, Miyata S, Shimokawa H (October 2017). "Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study". Eur J Heart Fail. 19 (10): 1258–1269. doi:10.1002/ejhf.807. PMID 28370829.
- ↑ Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J (September 2003). "Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial". Lancet. 362 (9386): 777–81. doi:10.1016/S0140-6736(03)14285-7. PMID 13678871.
- ↑ Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker SD, Thompson SG, Poole-Wilson PA (February 2005). "Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS)". Eur Heart J. 26 (3): 215–25. doi:10.1093/eurheartj/ehi115. PMID 15642700.
- ↑ 4.0 4.1 McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check
|pmid=
value (help). Vancouver style error: initials (help) - ↑ Borlaug BA (September 2020). "Evaluation and management of heart failure with preserved ejection fraction". Nat Rev Cardiol. 17 (9): 559–573. doi:10.1038/s41569-020-0363-2. PMID 32231333 Check
|pmid=
value (help). - ↑ Barandiarán Aizpurua A, Sanders-van Wijk S, Brunner-La Rocca HP, Henkens M, Heymans S, Beussink-Nelson L, Shah SJ, van Empel V (March 2020). "Validation of the HFA-PEFF score for the diagnosis of heart failure with preserved ejection fraction". Eur J Heart Fail. 22 (3): 413–421. doi:10.1002/ejhf.1614. PMID 31472035. Vancouver style error: initials (help)
- ↑ Ho JE, Zern EK, Wooster L, Bailey CS, Cunningham T, Eisman AS, Hardin KM, Zampierollo GA, Jarolim P, Pappagianopoulos PP, Malhotra R, Nayor M, Lewis GD (July 2019). "Differential Clinical Profiles, Exercise Responses, and Outcomes Associated With Existing HFpEF Definitions". Circulation. 140 (5): 353–365. doi:10.1161/CIRCULATIONAHA.118.039136. PMID 31132875.