Therapeutic interventions for heart failure with preserved ejection fraction:A summary of current evidence

Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.

Clinical characteristics and outcomes of octogenarians presenting with ST elevation myocardial infarction in the Australian population

AIM To investigate the characteristics and outcomes of octogenarians who presented with ST-elevation myocardial infarction(STEMI) compared to non-octogenarians and to investigate the outcomes of octogenarians that received primary percutaneous coronary intervention(PCI) compared to those managed conservatively.METHODS We performed a single center retrospective case controlled study. All octogenarians who presented with STEMI to a tertiary referring hospital between 2007 and 2012 were included. The subsequent non-octogenarian patient who presented with a STEMI following the octogenarian patient was assigned to the control group in a 1:1 manner. The outcomes measured were peri-procedural cardiac arrest, death on table, cerebrovascular accidents(CVA), in-hospital and 30-d mortality. RESULTS A total of 146 patients were analyzed. The octogenarian group had a higher percentage of females, higher overall comorbidities, higher Charlson Comorbidity Index score, worse renal function and were more likely to require residential care and home help. The octogenarian group were also less likely to have PCI attempted and had a longer symptom onset to PCItime. Mortality rate was high amongst octogenarians who presented with STEMI. However, those managed conservatively had a higher in-hospital and 30-d mortality rate CONCLUSION Octogenarians who presented with STEMI that were managed conservatively had a higher mortality rate compared to those who had primary PCI. Therefore,we propose that revascularization may be beneficial to patients in this age group.

Diabetic cardiomyopathy—What do we know about it?

Diabetic cardiomyopathy is defined as the presence of myocardial dysfunction in patients with diabetes in the absence of coronary artery disease, hypertension, or other known cardiac disease. Diabetes has been shown to affect the heart through various cellular mechanisms leading to enhanced myocardial fibrosis, left ventricular hypertrophy, systolic and diastolic dysfunction. With increasing incidence of type II diabetes mellitus, it has continuously rising health and financial implications in both developed and developing countries. Hyperglycaemia seems to be the main deriving force, and careful glycaemic control as well as early administration of neurohormonal antagonists currently remains the mainstay of therapy. Many newer treatment targets are currently being explored. Here we present a brief review of its pathophysiology, association with heart failure symptoms, and management strategies.