Is heart failure with preserved ejection fraction a ‘dementia’ of the heart?
- 27 April 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Heart Failure Reviews
- Vol. 27 (2), 587-594
- https://doi.org/10.1007/s10741-021-10114-9
Abstract
Heart failure with preserved ejection fraction (HFpEF) remains an elusive entity, due to its heterogeneous clinical profile and an arbitrarily defined nosology. Several pathophysiological mechanisms recognized as central for the development of HFpEF appear to be in common with the process of physiological aging of the heart. Both conditions are characterized by progressive impairment in cardiac function, accompanied by left ventricular hypertrophy, diastolic dysfunction, sarcomeric, and metabolic abnormalities. The neurological paradigm of dementia—intended as a progressive, multifactorial organ damage with decline of functional reserve, eventually leading to irreversible dysfunction—is well suited to represent HFpEF. In such perspective, certain phenotypes of HFpEF may be viewed as a maladaptive response to environmental modifiers, causing premature and pathological aging of the heart. We here propose that the ‘HFpEF syndrome’ may reflect the interplay of adverse structural remodelling and erosion of functional reserve, mirroring the processes leading to dementia in the brain. The resulting conceptual framework may help advance our understanding of HFpEF and unravel potential therapeutical targets.Keywords
This publication has 64 references indexed in Scilit:
- Comorbidity and Ventricular and Vascular Structure and Function in Heart Failure With Preserved Ejection FractionCirculation: Heart Failure, 2012
- The Intersection Between Aging and Cardiovascular DiseaseCirculation Research, 2012
- Arterial–Ventricular Coupling with Aging and DiseaseFrontiers in Physiology, 2012
- Determinants of Exercise Intolerance in Elderly Heart Failure Patients With Preserved Ejection FractionJournal of Invasive Cardiology, 2011
- Linking functional decline of telomeres, mitochondria and stem cells during ageingNature, 2010
- Contractility and Ventricular Systolic Stiffening in Hypertensive Heart Disease: Insights Into the Pathogenesis of Heart Failure With Preserved Ejection FractionJournal of Invasive Cardiology, 2009
- Calcium Cycling and Signaling in Cardiac MyocytesAnnual Review of Physiology, 2008
- Myocardial Structure and Function Differ in Systolic and Diastolic Heart FailureJournal of the American College of Cardiology, 2006
- Arterial and Cardiac Aging: Major Shareholders in Cardiovascular Disease EnterprisesJournal of the American College of Cardiology, 2003
- Cardiac excitation–contraction couplingNature, 2002