Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.

The aetiology of heart failure with preserved ejection fraction (HFpEF) is heterogenous and overlaps with that of several comorbidities like atrial fibrillation, diabetes mellitus, chronic kidney disease, valvular heart disease, iron deficiency, or sarcopenia. The diagnosis of HFpEF involves evaluating cardiac dysfunction through imaging techniques and assessing increased left ventricular filling pressure, which can be measured directly or estimated through various proxies including natriuretic peptides. To better narrow down the differential diagnosis of HFpEF, European and American heart failure guidelines advocate the use of different algorithms including comorbidities that require diagnosis and rigorous treatment during the evaluation process. Therapeutic recommendations differ between guidelines. Whilst sodium glucose transporter 2 inhibitors have a solid evidence base, the recommendations differ with regard to the use of inhibitors of the renin-angiotensin-aldosterone axis. Unless indicated for specific comorbidities, the use of beta-blockers should be discouraged in HFpEF. The aim of this article is to provide an overview of the current state of the art in HFpEF diagnosis, clinical evaluation, and treatment.

[Diabetes and Heart failure]. / Diabetes und Herzinsuffizienz.

Diabetes is a very important comorbidity in patients with heart failure. When both diseases are present, mortality is greatly increased. Therefore, it is important to sufficiently diagnose and treat patients with diabetes and heart failure to improve outcome. This article provides an overview on epidemiology, pathogeneses, diagnostic and therapeutic options.

[Evidence-based reduction of cardiovascular risk in patients with diabetes]. / Evidenzbasierte Reduktion des kardiovaskulären Risikos bei Diabetes.

Patients with type 2 diabetes mellitus exhibit a markedly increased propensity to develop cardiovascular diseases, such as myocardial infarction, stroke and heart failure. The results from large cardiovascular outcome trials conducted in recent years with novel hypoglycemic agents, such as dipeptidyl peptidase 4 (DPP-4) inhibitors, sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists have led to novel therapeutic strategies to reduce the cardiovascular risk in patients with diabetes. This overview article summarizes the evidence derived from these trials for the various substances. It also discusses the resulting treatment algorithms that have been brought together in the recently published European Society of Cardiology (ESC) guidelines on the topic of diabetes and cardiovascular diseases.