Interpretation of Universal Definition and Classification of Heart Failure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Xiaoju ,  LI Liwen

Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangzhou, 510000, P.R.China;

Corresponding?author：

LI Liwen, Email: gdghllw@163.com

Keywords：

Heart failure; left ventricular ejection fraction; natriuretic peptide; guideline interpretation

DOI：

10.7507/1007-4848.202106044

Video：

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The Universal Definition and Classification of Heart Failure consensus has proposed the universal definition, classification and staging criteria of heart failure. The prevalence of heart failure is still increasing, and the phenotype of heart failure with preserved ejection fraction (HFpEF) is becoming more and more common. Neuro-endocrine antagonists are effective in treating patients with heart failure with reduced ejection fraction (HFrEF). However, there is no effective drug that can improve the clinical prognosis of patients with HFpEF. The pathophysiological mechanism of HFpEF involves metabolic-inflammatory mechanism disorders, epicardial fat tissue accumulation, and coronary microvascular dysfunction. The exploratory treatment of these mechanisms requires further research to confirm whether it is beneficial to patients with HFpEF. In addition, the improvement of ejection fraction and the recovery of cardiac function in patients with HFrEF after treatment cannot interrupt the drug treatment of heart failure.

Citation： XIAO Xiaoju, LI Liwen. Interpretation of Universal Definition and Classification of Heart Failure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1140-1144. doi: 10.7507/1007-4848.202106044 Copy

1.	Bozkurt B, Coats AJS, Tsutsui H, et al. Universal Definition and Classification of Heart Failure. J Card Fail, 2021, 27(4): 387-413.
2.	Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 2017, 136(6): e137-e161.
3.	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37(27): 2129-2200.
4.	Writing committee members, Yancy CW, Jessup M, et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2013, 128(16): e240-e327.
5.	Tsutsui H, Isobe M, Ito H, et al. JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure — Digest version. Circ J, 2019, 83(10): 2084-2184.
6.	Ibrahim NE, Burnett JC, Butler J, et al. Natriuretic peptides as inclusion criteria in clinical trials: A JACC: Heart failure position paper. JACC Heart Fail, 2020, 8(5): 347-358.
7.	Wilcox JE, Fang JC, Margulies KB, et al. Heart failure with recovered left ventricular ejection fraction: JACC scientific expert panel. J Am Coll Cardiol, 2020, 76(6): 719-734.
8.	中華醫學會心血管病學分會心力衰竭學組, 中國醫師協會心力衰竭專業委員會, 中華心血管病雜志編輯委員會. 中國心力衰竭診斷和治療指南2018. 中華心血管病雜志, 2018, 46(10): 760-789.
9.	Hollenberg SM, Warner Stevenson L, Ahmad T, et al. 2019 ACC expert consensus decision pathway on risk assessment, management, and clinical trajectory of patients hospitalized with heart failure: A report of the American College of Cardiology solution set oversight committee. J Am Coll Cardiol, 2019, 74(15): 1966-2011.
10.	廖玉華, 楊杰孚, 張健, 等. 舒張性心力衰竭診斷和治療專家共識. 臨床心血管病雜志, 2020, 36(1): 1-10.
11.	Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med, 2019, 381(17): 1609-1620.
12.	Shah AM, Pfeffer MA. The many faces of heart failure with preserved ejection fraction. Nat Rev Cardiol, 2012, 9(10): 555-556.
13.	Shah SJ, Katz DH, Deo RC. Phenotypic spectrum of heart failure with preserved ejection fraction. Heart Fail Clin, 2014, 10(3): 407-418.
14.	Ge JB. Coding proposal on phenotyping heart failure with preserved ejection fraction: A practical tool for facilitating etiology-oriented therapy. Cardiol J, 2020, 27(1): 97-98.
15.	Packer M. Epicardial adipose tissue may mediate deleterious effects of obesity and inflammation on the myocardium. J Am Coll Cardiol, 2018, 71(20): 2360-2372.
16.	Sarzani R, Marcucci P, Salvi F, et al. AngiotensinⅡ stimulates and atrial natriuretic peptide inhibits human visceral adipocyte growth. Int J Obes (Lond), 2008, 32(2): 259-267.
17.	Shah SJ, Lam CSP, Svedlund S, et al. Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF. Eur Heart J, 2018, 39(37): 3439-3450.
18.	Taqueti VR, Solomon SD, Shah AM, et al. Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction. Eur Heart J, 2018, 39(10): 840-849.
19.	Paulus WJ, Tsch?pe 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(4): 263-271.
20.	Kong Q, Blanton RM. Protein kinase G I and heart failure: Shifting focus from vascular unloading to direct myocardial antiremodeling effects. Circ Heart Fail, 2013, 6(6): 1268-1283.
21.	van Heerebeek L, Hamdani N, Falc?o-Pires I, et al. Low myocardial protein kinase G activity in heart failure with preserved ejection fraction. Circulation, 2012, 126(7): 830-839.
22.	Halliday BP, Wassall R, Lota AS, et al. Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): An open-label, pilot, randomised trial. Lancet, 2019, 393(10166): 61-73.

1. Bozkurt B, Coats AJS, Tsutsui H, et al. Universal Definition and Classification of Heart Failure. J Card Fail, 2021, 27(4): 387-413.
2. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 2017, 136(6): e137-e161.
3. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37(27): 2129-2200.
4. Writing committee members, Yancy CW, Jessup M, et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2013, 128(16): e240-e327.
5. Tsutsui H, Isobe M, Ito H, et al. JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure — Digest version. Circ J, 2019, 83(10): 2084-2184.
6. Ibrahim NE, Burnett JC, Butler J, et al. Natriuretic peptides as inclusion criteria in clinical trials: A JACC: Heart failure position paper. JACC Heart Fail, 2020, 8(5): 347-358.
7. Wilcox JE, Fang JC, Margulies KB, et al. Heart failure with recovered left ventricular ejection fraction: JACC scientific expert panel. J Am Coll Cardiol, 2020, 76(6): 719-734.
8. 中華醫學會心血管病學分會心力衰竭學組, 中國醫師協會心力衰竭專業委員會, 中華心血管病雜志編輯委員會. 中國心力衰竭診斷和治療指南2018. 中華心血管病雜志, 2018, 46(10): 760-789.
9. Hollenberg SM, Warner Stevenson L, Ahmad T, et al. 2019 ACC expert consensus decision pathway on risk assessment, management, and clinical trajectory of patients hospitalized with heart failure: A report of the American College of Cardiology solution set oversight committee. J Am Coll Cardiol, 2019, 74(15): 1966-2011.
10. 廖玉華, 楊杰孚, 張健, 等. 舒張性心力衰竭診斷和治療專家共識. 臨床心血管病雜志, 2020, 36(1): 1-10.
11. Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med, 2019, 381(17): 1609-1620.
12. Shah AM, Pfeffer MA. The many faces of heart failure with preserved ejection fraction. Nat Rev Cardiol, 2012, 9(10): 555-556.
13. Shah SJ, Katz DH, Deo RC. Phenotypic spectrum of heart failure with preserved ejection fraction. Heart Fail Clin, 2014, 10(3): 407-418.
14. Ge JB. Coding proposal on phenotyping heart failure with preserved ejection fraction: A practical tool for facilitating etiology-oriented therapy. Cardiol J, 2020, 27(1): 97-98.
15. Packer M. Epicardial adipose tissue may mediate deleterious effects of obesity and inflammation on the myocardium. J Am Coll Cardiol, 2018, 71(20): 2360-2372.
16. Sarzani R, Marcucci P, Salvi F, et al. AngiotensinⅡ stimulates and atrial natriuretic peptide inhibits human visceral adipocyte growth. Int J Obes (Lond), 2008, 32(2): 259-267.
17. Shah SJ, Lam CSP, Svedlund S, et al. Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF. Eur Heart J, 2018, 39(37): 3439-3450.
18. Taqueti VR, Solomon SD, Shah AM, et al. Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction. Eur Heart J, 2018, 39(10): 840-849.
19. Paulus WJ, Tsch?pe 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(4): 263-271.
20. Kong Q, Blanton RM. Protein kinase G I and heart failure: Shifting focus from vascular unloading to direct myocardial antiremodeling effects. Circ Heart Fail, 2013, 6(6): 1268-1283.
21. van Heerebeek L, Hamdani N, Falc?o-Pires I, et al. Low myocardial protein kinase G activity in heart failure with preserved ejection fraction. Circulation, 2012, 126(7): 830-839.
22. Halliday BP, Wassall R, Lota AS, et al. Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): An open-label, pilot, randomised trial. Lancet, 2019, 393(10166): 61-73.

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