Download PDF
Dtsch Med Wochenschr 2020; 145(19): 1377-1383
DOI: 10.1055/a-1038-7678
Dossier

Medikamentöse Therapie bei Herzinsuffizienz mit erhaltener Pumpfunktion

Pharmaceutical Treatment Options in Heart Failure with Preserved Ejection Fraction
Tobias Daniel Trippel
,
Carsten Tschöpe
› Further Information
Also available at
    Permissions and Reprints

Die Herzinsuffizienz mit erhaltener Pumpfunktion verläuft prognostisch so bedrohlich wie bösartige Krebserkrankungen, führt zu häufigen Krankenhausaufenthalten und bringt enorme soziale und ökonomische Kosten mit sich. In der symptom- und risikofaktorenbasierten medikamentösen Behandlung werden meist Diuretika, Renin-Angiotensin-Aldosteron-Inhibitoren (RAASi) und ggf. Antidiabetika eingesetzt. Eine kausale Therapie ist nicht etabliert.

Abstract

Heart Failure causes an enormous individual and societal burden of disease with severe symptoms, a reduction in activities of daily life, frequent hospitalizations and poor prognosis. The field of heart failure with reduced ejection fraction has seen substantial innovation in the past years. Novel and successful treatment regimens were established, the pharmaceutical treatment options for heart failure with preserved ejection fraction remains limited to date. Yet, promising concepts are emerging. Today we have only symptoms and risk factors-based therapeutic options, and include basically diuretics, RAAsi, and antidiabetics, respectively. A causal therapy is still missing.

Schlüsselwörter

Herzinsuffizienz - HFpEF - Diagnose - Therapie - Behandlung

Key words

heart failure - heart failure with preserved ejection fraction - treatment


Publication History

Article published online:
24 September 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Pieske B, Tschöpe C, de Boer RA. et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2019; 40 (40) 3297-3317
    CrossrefPubMedGoogle Scholar
  • 2 Reddy YNV, Carter RE, Obokata M. et al. A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction. Circulation 2018; 138 (09) 861-870
    CrossrefPubMedGoogle Scholar
  • 3 Massie B, Carson PE, McMuarray JJ. et al. Irbesartan in patients with heart failure and preserved ejection fraction. NEJM 2014; 355: 251-259
    PubMedGoogle Scholar
  • 4 Pitt B, PFeffer MA, Assmann SF. et al. Spironolactone for heart failure with preserved ejection fraction. NEJM 2014; 370: 1383-1392
    CrossrefPubMedGoogle Scholar
  • 5 Edelmann F, Gelbrich G, Düngen HD. et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. JACC 2011; 58 (17) 1780-1791
    CrossrefPubMedGoogle Scholar
  • 6 Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 2013; 62 (04) 263-271
    CrossrefPubMedGoogle Scholar
  • 7 Ponikowksi P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. EHJ 2016; 37 (27) 2129-2200
    CrossrefPubMedGoogle Scholar
  • 8 Tschöpe C, Birner C, Böhm M. et al. U.Heart failure with preserved ejection fraction: current management and future strategies: Expert opinion on the behalf of the Nucleus of the “Heart Failure Working Group” of the German Society of Cardiology (DKG). Clin Res Cardiol 2018; 107 (01) 1-19
    CrossrefPubMedGoogle Scholar
  • 9 Solomon SD, McMurray JJV, Anand IS. et al. Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. NEJM 2019; 381 (17) 1609-1620
    CrossrefPubMedGoogle Scholar
  • 10 Pouleur AC, Anker SD, Brito D. et al. Rationale and design of a multicentre, randomized, placebo-controlled trial of mirabegron, a Beta3-adrenergic receptor agonist on left ventricular mass and diastolic function in patients with structural heart disease Beta3-left ventricular hypertrophy (Beta3-LVH). ESC Heart Fail 2018; 5 (05) 830-841
    CrossrefPubMedGoogle Scholar
  • 11 Pieske B, Maggioni AP, Lam CSP. et al. Vericiguat in patients with worsening chronic heart failure and preserved ejection fraction: results of the SOluble guanylate Cyclase stimulatoR in heArT failurE patientS with PRESERVED EF (SOCRATES-PRESERVED) study. Eur Heart J 2017; 38 (15) 1119-1127
    CrossrefPubMedGoogle Scholar
  • 12 Pabel S, Wagner S, Bollenberg H. et al. Empagliflozin directly improves diastolic function in human heart failure. Eur J Heart Fail 2018; 20 (12) 1690-1700
    CrossrefPubMedGoogle Scholar
  • 13 Kolijn D, Pabel S, Tian Y. et al Empagliflozin improves endothelial and cardiomyocyte function in human heart failure with preserved ejection fraction via reduced pro-inflammatory-oxidative pathways and protein kinase Gα oxidation. Cardiovasc Res. 2020 May 12:cvaa123
    PubMedGoogle Scholar
  • 14 Kasner M, Westermann D, Lopez B. et al. Diastolic tissue Doppler indexes correlate with the degree of collagen expression and cross-linking in heart failure and normal ejection fraction. J Am Coll Cardiol 2011; 57 (08) 977-985
    CrossrefPubMedGoogle Scholar
  • 15 Yang J, Savvatis K, Kang JS. et al. Targeting LOXL2 for cardiac interstitial fibrosis and heart failure treatment. Nat Commun 2016; 7: 13710
    CrossrefPubMedGoogle Scholar
  • 16 Chatfield KC, Sparagna GC, Chau S. et al. Elamipretide Improves Mitochondrial Function in the Failing Human Heart. JACC Basic Transl Sci 2019; 4 (02) 147-157
    CrossrefPubMedGoogle Scholar
  • 17 Tomasoni D, Adamo M, Lombardi CM. et al. Highlights in heart failure. ESC Heart Fail 2019; 6: 1105-1127
    CrossrefPubMedGoogle Scholar
  • 18 Everett BM, Cornel JH, Lainscak M. et al. Anti-inflammators therapy with Canakinumab for the prevention of hospitalization for heart failure. Circulation 2019; 139 (10) 1289-1299
    CrossrefPubMedGoogle Scholar
  • 19 Tschöpe C, Van Linthout S, Kherad B. Heart Failure with Preserved Ejection Fraction and Future Pharmacological Strategies: a Glance in the Crystal Ball. Curr Cardiol Rep 2017; 19 (08) 70
    CrossrefPubMedGoogle Scholar
  • 20 Wintrich J, Kindermann I, Ukena C. et al. Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future. Clin Res Cardiol 2020; DOI: 10.1007/s00392-020-01633-w.
    CrossrefPubMedGoogle Scholar
  • 21 Ho CY, Mealiffe ME, Bach RG. et al. Evaluation of Mavacamten in Symptomatic Patients With Nonobstructive Hypertrophic Cardiomyopathy. JACC 2020; 75 (21) 2649-2660
    CrossrefPubMedGoogle Scholar
  • 22 Angermann CE, Assmus B, Anker SD. et al. Safety and feasibility of pulmonary artery pressure-guided heart failure therapy: rationale and design of the prospective CardioMEMS Monitoring Study for Heart Failure (MEMS-HF). Clin Res Cardiol 2018; 107: 991-1002
    CrossrefPubMedGoogle Scholar
  • 23 Leung CC. Current Role of the CardioMEMS Device for Management of Patients with Heart Failure. Curr Cardiol Rep 2019; 21: 98
    CrossrefPubMedGoogle Scholar