[Update on diastolic heart failure]. / Update zur diastolisch bedingten Herzinsuffizienz.

In August 2021, an update of the European Society of Cardiology-Heart Failure Association guideline for the diagnosis and treatment of heart failure was released. To review the changes implied by current guidelines regarding the diagnosis and treatment of patients with heart failure and preserved left ventricular ejection fraction (HFpEF). The diagnosis of HFpEF requires the combined presence of clinical signs, left ventricular ejection fraction ≥ 50%, elevated natriuretic peptides, and elevated left ventricular filling pressure. If the diagnosis remains equivocal, a stress test is recommended. The targeted identification and treatment of comorbid conditions is key for a holistic therapeutic approach to HFpEF. Diuretics are recommended in congested patients with HFpEF in order to alleviate signs and symptoms. The treatment of diabetic patients with heart failure should include a sodium glucose co-transporter­2 (SGLT2) inhibitor. All patients with HFpEF should be enrolled in a multidisciplinary heart failure management program aiming to improve self-care strategies and offer participation in an exercise program. It was recently shown for the first time in a randomized trial that hard clinical endpoints could be reduced in patients with HFpEF using the SGLT2 inhibitor empagliflozin. It is expected that this finding will become part of updated treatment recommendations in the near future. Although challenging, the early diagnosis of HFpEF is key to averting the poor prognosis associated with this frequent condition. Multidisciplinary care and innovative pharmacologic and non-pharmacologic therapies, however, can improve quality of life, exercise tolerance, and prognosis.

Improvement of Shen'ge formula on heart function in diastolic heart failure: A protocol for randomized, double-blind, placebo-controlled clinical study.

INTRODUCTION: Diastolic heart failure (DHF) is an important pathological type of heart failure, that involves multiple organ dysfunction and multiple complications. The prevalence of DHF is high, and effective treatments are lacking. Chinese herbs are an alternative therapy for DHF. Shen'ge formula (SGF) is a classical formula from which patients can benefit, but convincing evidence of its efficacy is lacking. Therefore, we designed this randomized controlled trial protocol. METHODS/DESIGN: This randomized, double-blind, placebo-controlled clinical trial will evaluate the efficacy and safety of SGF in the treatment of DHF. A total of 130 patients with DHF will be enrolled in the trial and treated with SGF granules or placebo for 12 weeks and followed up for 12 weeks. The primary outcome measurement will be to changes in plasma N-terminal brain natriuretic peptide precursor before versus after treatment, while the second primary outcome measurement will be changes in heart function before versus after treatment and the 12-week follow-up period. It will also include echocardiography, a cardiopulmonary exercise test, cardiac function grading, traditional Chinese medicine syndrome score, and the Minnesota Heart Failure Quality of Life Scale. Adverse events will be evaluated throughout the trial. DISCUSSION: The results of this trial will demonstrate whether SGF could alleviate symptoms, improve cardiac function, reduce readmission rates, and improve quality of life of patients with DHF. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR2000036533, registered on August 24, 2020.

Suplementação de vitamina D na insuficiência cardíaca com fração de ejeção normal: impacto na qualidade de vida: estudo FITNESS / Vitamin D supplementation in normal ejection fraction heart: impact on quality of life: FITNESS study

Fundamentos: Estudos demonstram a importante prevalência do déficit de vitamina D (vit. D) em pacientes com insuficiência cardíaca com fração deejeção reduzida (ICFER). O déficit de vit. D se relaciona com a piora na qualidade de vida e redução do desempenho funcional. Com o envelhecimento, a insuficiência cardíaca com fração de ejeção normal (ICFEN) tornar-se-á o tipo de insuficiência cardíaca mais comum, com resultados referentes ao prognóstico semelhantes aos da ICFER. Apesar das evidências daação benéfica da vit. D no sistema cardiovascular em pacientes com ICFER, não há estudos clínicos que demonstrem a melhora morfofuncional cardiovascularcom a suplementação de vit.D em pacientes com ICFEN. Objetivo: Demonstrar a melhora da qualidade de vida e função diastólica em pacientes com ICFEN, após suplementação de vit. D. Métodos: E s t u d o p ro s p e c t i v o , d u p l o-c e g o randomizado, placebo controlado, envolvendo 40 pacientes com ICFEN e deficiência de vit. D (25OHD<30ng/mL), por 20 semanas de tratamento. Os pacientes receberão suplementação de 100.000UI decolecalciferol ou placebo no início do estudo e na 10ª semana, sob supervisão médica. Os pacientes serão avaliados por: testes funcionais (timed up and go test e 6 minute walk test), exames laboratoriais, questionário Minnesota Living with Heart Failure, eletrocardiograma e ecoDopplercardiograma, avaliando a função sistólica, a diastólica e o remodelamento ventricular no início doestudo, em 10 semanas e em 20 semanas. Conclusão: O estudo FITNESS avaliará o impacto morfofuncional cardiovascular e na qualidade de vida em 20 semanas na suplementação de colecalciferol em pacientes com ICFEN e déficit de vit. D.

Background: Studies have shown a significant prevalence of vitamin D (Vit. D) deficits in heart failure patients with reduced ejection fraction(HFREF), related to poorer quality of life andreductions in functional performance. With anaging population, heart failure with preserved ejection fraction (HFPEF) will become the most common type of heart failure (HF), with similar results for HFREF predictions. Despite evidence of the beneficial action of vit. D on the cardiovascular system in HFREF patients, there are no clinical s t u d i e s demo n s t r a t i n g c a rd i o v a s c u l a r morphofunctional improvement through vit.D supplementation in HFPEF patients. Objective: To demonstrate improvements in the quality of life and diastolic function for FPEF patients taking vit. D supplements. Methods: Prospective, double-blind, randomized, placebo-controlled study, with 40 patients with HFNEF and vit. D deficiency (25OHD <30ng/mL)for 20 weeks of treatment. Patients will receive supplements of 100,000IU of cholecalciferol (Vit. D3)or placebo at baseline and at 10 weeks under medical supervision. They will be assessed by: functional tests (timed up-and-go test and 6-minute walk test),laboratory examinations, the Minnesota Living with Heart Failure Questionnaire, electrocardiogram, evaluating systolic and diastolic functions and ventricular remodeling at baseline, and at 10 and 20weeks.Conclusion: The FITNESS study will evaluate cardiovascular morphofunctional impacts and effects on the quality of life during 20 weeks of cholecalciferol supplementation in HFPEF patients with vit. D deficits.