American Heart Association

HFpEF

Adenosine-induced vasodilation is impaired and may be a therapeutic target in HFpEF

Contributor: Seyedeh Maryam Hosseini, MD

Heart failure with preserved ejection fraction is characterized by impaired cardiovascular reserve and coronary microvascular dysfunction. Tissue hypoxia activates endogenous adenosine secretion leading to vasodilation of the myocardial microvasculature. By increasing tissue perfusion in working myocardium, adenosine responds to increased metabolic demand. Davila et al. demonstrate that this adenosine vasodilation mechanism is impaired in HFpEF due to up-regulation of the adenosine kinase (ADK) enzyme gene. ADK changes adenosine to its inactive form. Increasing endogenous adenosine by inhibiting the ADK enzyme pharmacologically may have therapeutic potential to improve coronary vasodilation, myocardial perfusion and LV diastolic dysfunction in HFpEF.

VITALITY-HFpEF: Designed to test the hypothesis that vericiguat may improve physical functioning in patients with HFpEF

Contributor: Emily Cendrowski

VITALITY-HFPEF is a trial underway which will evaluate the efficacy of vericiguat in HFpEF patients by using the KCCQ-PLS (Kansas City Cardiomyopathy Questionnaire Physical Limitation Score) as a primary endpoint. The choice of this primary endpoint will make it the first HF trial utilizing a quality of life, patient-reported outcome (PRO) as a primary endpoint. There remains a need for medications which improve mortality and functional status for patients with HFpEF. An ongoing area of research involves the cyclic guanosine monophosphate (cGMP) pathway.

Proenkephalin: a novel marker of renal dysfunction in heart failure

Contributor: Nicole Smith

Is the opioid system responsible for deteriorating renal function in heart failure?

In a large chronic HF study population, Emmens and colleagues demonstrated higher levels of the opioid surrogate proenkephalin (PENK) are associated with worse HF and deterioration of kidney function. Could PENK be the next renal biomarker in heart failure?

NT-proBNP Levels Less Predictive in HFpEF with Atrial Fibrillation

Contributors: Ike Chinyere and Michela Brambatti

N-Terminal Pro-B-Type Natriuretic Peptide Levels for Risk Prediction in Patients With Heart Failure and Preserved Ejection Fraction According to Atrial Fibrillation Status

Study Link: N-Terminal Pro-B-Type Natriuretic Peptide Levels for Risk Prediction in Patients With Heart Failure and Preserved Ejection Fraction According to Atrial Fibrillation Status

Bonus! Waveform

NT-proBNP is more predictive of unfavorable outcomes in HFpEF in the absence of AFib

Contributor: Martin Chacon

Does an increased NT-proBNP in patients with atrial fibrillation (AF) and HFpEF correspond to a higher risk for worse outcomes? Kristensen et al suggest increased NTproBNP levels do not show the same correlation with poor outcomes in patients with AF compared with those without AF. NT-proBNP is increased in AF patients independently from heart failure, therefore, its capacity to predict cardiovascular death or hospitalizations in HFpEF may be diminished.