Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Thomas M. Gorter; Dirk J. van Veldhuisen; Johann Bauersachs; Barry A. Borlaug; Jelena Celutkiene; Andrew J.S. Coats; Marisa G. Crespo-Leiro; Marco Guazzi; Veli Pekka Harjola; Stephane Heymans; Loreena Hill; Mitja Lainscak; Carolyn S.P. Lam; Lars H. Lund; Alexander R. Lyon; Alexandre Mebazaa; Christian Mueller; Walter J. Paulus; Burkert Pieske; Massimo F. Piepoli; Frank Ruschitzka; Frans H. Rutten; Petar M. Seferovic; Scott D. Solomon; Sanjiv J. Shah; Filippos Triposkiadis; Rolf Wachter; Carsten Tschöpe; Rudolf A. de Boer

doi:10.1002/ejhf.1029

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Thomas M. Gorter, Dirk J. van Veldhuisen, Johann Bauersachs, Barry A. Borlaug, Jelena Celutkiene, Andrew J.S. Coats, Marisa G. Crespo-Leiro, Marco Guazzi, Veli Pekka Harjola, Stephane Heymans, Loreena Hill, Mitja Lainscak, Carolyn S.P. Lam, Lars H. Lund, Alexander R. Lyon, Alexandre Mebazaa, Christian Mueller, Walter J. Paulus, Burkert Pieske, Massimo F. PiepoliFrank Ruschitzka, Frans H. Rutten, Petar M. Seferovic, Scott D. Solomon, Sanjiv J. Shah, Filippos Triposkiadis, Rolf Wachter, Carsten Tschöpe, Rudolf A. de Boer^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

246 Scopus citations

Abstract

There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed.

Original language	English (US)
Pages (from-to)	16-37
Number of pages	22
Journal	European Journal of Heart Failure
Volume	20
Issue number	1
DOIs	https://doi.org/10.1002/ejhf.1029
State	Published - Jan 2018

Funding

The authors thank Gerasimos S. Filippatos (National and Kapodis-trian University of Athens, School of Medicine, Athens University Hospital Attikon, Athens, Greece) for support and useful suggestions. Dr. de Boer is supported by the Netherlands Heart Foundation (CVON-DOSIS, grant 2014-40) and the Innovational Research Incentives Scheme program of the Netherlands Organization for Scientific Research (NWO VIDI, grant 917.13.350). Conflict of interest: T.M.G. reports no conflict of interest; D.J.v.V. reports no conflict of interest; J.B. reports grants from Bayer and MSD, outside the submitted work; B.A.B. reports support from Aires Pharmaceuticals, Inc., GlaxoSmithKline and Medtronic, and personal fees from Amgen and Merck & Co, Inc., outside the submitted work; J.C. reports grants from Lithuanian Research Council, non-financial support from Medispec, and personal fees from Novartis, Servier, Orivas, Amgen, and Grindex, outside the submitted work; A.J.S.C. reports no conflict of interest; M.G.C-L. reports no conflict of interest; M.G. reports no conflict of interest; V-P.H. reports personal fees from Orion Pharma, outside the submitted work; S.H. reports no conflict of interest; L.H. reports no conflict of interest; M.L. reports no conflict of interest; C.S.P.L. reports grants from National Medical Research Council of Singapore, non-financial support from Boston Scientific, Bayer, Thermofisher, Medtronic, Vifor Pharma, personal fees from Bayer, Novartis, Takeda, Merck, Astra Zeneca, Janssen Research & Development, LLC, Menarini, Boehringer Ingelheim, Abbott Diagnostics, Corvia, Stealth BioTherapeutics, Roche and Amgen, and dr. Lam has a patent PCT/SG2016/050217 pending, outside the submitted work; L.H.L. reports consultancy fees from Bayer, AstraZeneca, ViforPharma, Novartis, Sanofi, Fresenius and Relypsa, institutional grants from ViforPharma, Boehringer Ingel-heim and Boston Scientific, speaker fees and/or travel expenses from Novartis, AstraZeneca and St Jude, outside the submitted work; A.R.L. reports no conflict of interest; A.M. reports personal fees from Novartis, Orion, Roche, Servier, Zs Pharma and Cardiorentis, grants and personal fees from Adrenomed, grants from MyCartis, Critical Diagnostics, outside the submitted work; C.M. reports grants, personal fees and non-financial support from Several diagnostic companies, outside the submitted work; W.J.P. reports no conflict of interest; B.P. reports no conflict of interest; M.F.P. reports no conflict of interest; F.R. reports grants and/or personal fees from St Jude Medical, Servier, Zoll, AstraZeneca, Sanofi, Cardiorentis, Novartis, Amgen, BMS, Pfizer,

Keywords

Biomarkers
Heart failure
Heart failure with preserved ejection fraction
Pulmonary hypertension
Right ventricular function

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1002/ejhf.1029

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Gorter, T. M., van Veldhuisen, D. J., Bauersachs, J., Borlaug, B. A., Celutkiene, J., Coats, A. J. S., Crespo-Leiro, M. G., Guazzi, M., Harjola, V. P., Heymans, S., Hill, L., Lainscak, M., Lam, C. S. P., Lund, L. H., Lyon, A. R., Mebazaa, A., Mueller, C., Paulus, W. J., Pieske, B., ... de Boer, R. A. (2018). Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 20(1), 16-37. https://doi.org/10.1002/ejhf.1029

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title = "Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology",

abstract = "There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed.",

keywords = "Biomarkers, Heart failure, Heart failure with preserved ejection fraction, Pulmonary hypertension, Right ventricular function",

author = "Gorter, {Thomas M.} and {van Veldhuisen}, {Dirk J.} and Johann Bauersachs and Borlaug, {Barry A.} and Jelena Celutkiene and Coats, {Andrew J.S.} and Crespo-Leiro, {Marisa G.} and Marco Guazzi and Harjola, {Veli Pekka} and Stephane Heymans and Loreena Hill and Mitja Lainscak and Lam, {Carolyn S.P.} and Lund, {Lars H.} and Lyon, {Alexander R.} and Alexandre Mebazaa and Christian Mueller and Paulus, {Walter J.} and Burkert Pieske and Piepoli, {Massimo F.} and Frank Ruschitzka and Rutten, {Frans H.} and Seferovic, {Petar M.} and Solomon, {Scott D.} and Shah, {Sanjiv J.} and Filippos Triposkiadis and Rolf Wachter and Carsten Tsch{\"o}pe and {de Boer}, {Rudolf A.}",

note = "Publisher Copyright: {\textcopyright} 2017 The Authors. European Journal of Heart Failure {\textcopyright} 2017 European Society of Cardiology",

year = "2018",

month = jan,

doi = "10.1002/ejhf.1029",

language = "English (US)",

volume = "20",

pages = "16--37",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "Oxford University Press",

number = "1",

}

Gorter, TM, van Veldhuisen, DJ, Bauersachs, J, Borlaug, BA, Celutkiene, J, Coats, AJS, Crespo-Leiro, MG, Guazzi, M, Harjola, VP, Heymans, S, Hill, L, Lainscak, M, Lam, CSP, Lund, LH, Lyon, AR, Mebazaa, A, Mueller, C, Paulus, WJ, Pieske, B, Piepoli, MF, Ruschitzka, F, Rutten, FH, Seferovic, PM, Solomon, SD, Shah, SJ, Triposkiadis, F, Wachter, R, Tschöpe, C & de Boer, RA 2018, 'Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology', European Journal of Heart Failure, vol. 20, no. 1, pp. 16-37. https://doi.org/10.1002/ejhf.1029

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. / Gorter, Thomas M.; van Veldhuisen, Dirk J.; Bauersachs, Johann et al.
In: European Journal of Heart Failure, Vol. 20, No. 1, 01.2018, p. 16-37.

Research output: Contribution to journal › Article › peer-review

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T1 - Right heart dysfunction and failure in heart failure with preserved ejection fraction

T2 - mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

AU - Gorter, Thomas M.

AU - van Veldhuisen, Dirk J.

AU - Bauersachs, Johann

AU - Borlaug, Barry A.

AU - Celutkiene, Jelena

AU - Coats, Andrew J.S.

AU - Crespo-Leiro, Marisa G.

AU - Guazzi, Marco

AU - Harjola, Veli Pekka

AU - Heymans, Stephane

AU - Hill, Loreena

AU - Lainscak, Mitja

AU - Lam, Carolyn S.P.

AU - Lund, Lars H.

AU - Lyon, Alexander R.

AU - Mebazaa, Alexandre

AU - Mueller, Christian

AU - Paulus, Walter J.

AU - Pieske, Burkert

AU - Piepoli, Massimo F.

AU - Ruschitzka, Frank

AU - Rutten, Frans H.

AU - Seferovic, Petar M.

AU - Solomon, Scott D.

AU - Shah, Sanjiv J.

AU - Triposkiadis, Filippos

AU - Wachter, Rolf

AU - Tschöpe, Carsten

AU - de Boer, Rudolf A.

PY - 2018/1

Y1 - 2018/1

N2 - There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed.

AB - There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed.

KW - Biomarkers

KW - Heart failure

KW - Heart failure with preserved ejection fraction

KW - Pulmonary hypertension

KW - Right ventricular function

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U2 - 10.1002/ejhf.1029

DO - 10.1002/ejhf.1029

M3 - Article

C2 - 29044932

AN - SCOPUS:85041471654

SN - 1388-9842

VL - 20

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JO - European Journal of Heart Failure

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Gorter TM, van Veldhuisen DJ, Bauersachs J, Borlaug BA, Celutkiene J, Coats AJS et al. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2018 Jan;20(1):16-37. doi: 10.1002/ejhf.1029

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

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