Randomized clinical trials have failed to demonstrate a prognostic benefit from neurohormonal modulation therapies in HFpEF, with the exception of patients with left ventricular ejection fraction in the lower range of normality.
Do neurohormonal modulation therapies improve clinical outcomes in patients with heart failure with preserved ejection fraction?
This review highlights that while neurohormonal activation occurs in HFpEF, targeted therapies have not yielded the same prognostic benefits as in HFrEF, except potentially in those with mildly reduced ejection fraction.
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome resulting from the interaction between cardiac diseases, comorbidities and ageing. HFpEF is characterised by the activation of neurohormonal axes, namely of the renin-angiotensin-aldosterone system and the sympathetic nervous system, although to a lesser extent compared with heart failure with reduced ejection fraction. This provides a rationale for neurohormonal modulation as a therapeutic approach for HFpEF. Nonetheless, randomised clinical trials have failed to demonstrate a prognostic benefit from neurohormonal modulation therapies in HFpEF, with the sole exception of patients with left ventricular ejection fraction in the lower range of normality, for whom the American guidelines suggest that such therapies may be considered. In this review, the pathophysiological rationale for neurohormonal modulation in HFpEF is summarised and the clinical evidence on pharmacological and nonpharmacological approaches backing current recommendations discussed.
Castiglione et al. (Mon,) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Neurohormonal modulation therapies was evaluated. Randomized clinical trials have failed to demonstrate a prognostic benefit from neurohormonal modulation therapies in HFpEF, with the exception of patients with left ventricular ejection fraction in the lower range of normality.