MedicalResearch: What is the background for this review? What are the main findings?
Dr. Pedrotty: Heart failure (HF) is the most common cause for hospitalization among patients 65 years and older, affecting approximately 6 million Americans; at 40 years of age, American males and females have a one in five lifetime risk of developing heart failure. There are two distinct heart failure phenotypes: a syndrome with normal or near-normal left ventricular ejection fraction (LVEF) referred to as HF with preserved ejection fraction (HFpEF), and the phenotype associated with poor cardiac contractility or heart failure with reduced ejection fraction (HFrEF). Risk factors associated with HFpEF include female gender, especially women with diabetes, higher body mass index, smoking, hypertension, concentric left ventricular hypertrophy (LVH), and atrial fibrillation (AF). There has been a growing interest in the development of criteria for specific subsets of HFpEF, a syndromal disease where multiple cardiac and vascular abnormalities exist. One approach is to implement phenomapping, identifying phenotypically distinct HFpEF categories and developing a classification system to group together pathophysiologically similar individuals who may respond in a more homogeneous, predictable way to intervention. Another option would be to focus on a known physiologic differences which might shed light on pathologic mechanisms e.g. gender and the influences of obesity and atrial fibrillation.
MedicalResearch What should clinicians and patients take away from your publication?
Dr. Pedrotty: The easily ascertained phenotypes of gender, obesity and atrial fibrillation have been and are available now; gender is binary, while obesity and AF can be further divided into discrete subsets. These 3 clinical phenotypes (obesity, gender and atrial fibrillation) are characterized by abnormal fibrosis and inflammatory responses which have been shown to be pathophysiologically related to patients diagnosed clinically with HFpEF. Thus, extent of myocardial fibrosis could be examined in Heart Failure with preserved ejection fraction women with and without atrial fibrillation, or with various degrees of obesity. The physiologic abnormalities could be linked to clinical outcomes. Applying our knowledge of gender differences in cardiac remodeling, vascular biology, and cardiac arrhythmias to the larger dilemma of the HFpEF syndrome is one that should not be overlooked.
MedicalResearch What recommendations do you have for future research as a result of this report?
Dr. Pedrotty: Future mechanistic investigations about Heart Failure with preserved ejection fraction should be focused on the overlap of the risk factors, instead of differences, with gender at the epicenter. As we continue forward we hope we will be able to elucidate which subgroups share common pathways. Understanding the common pathways can help to better understand the mechanisms that cause HFpEF; specifically with respect to the development of therapeutic options which will hopefully change outcomes.
MedicalResearch.com Interview with: Dawn Pedrotty, MD, PhD (2015). Research Aims To Understand Heart Failure In Women