Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

• Published in: JACC. Basic to translational science 2021-09, Vol.6 (9-10), p.772-795
• Main Authors: Rosalia, Luca, Ozturk, Caglar, Shoar, Saeed, Fan, Yiling, Malone, Grainne, Cheema, Faisal H., Conway, Claire, Byrne, Robert A., Duffy, Garry P., Malone, Andrew, Roche, Ellen T., Hameed, Aamir
• Format: Article
• Language: English
• Subjects: atrial shunt devices; electrostimulation; heart failure devices; heart failure with preserved ejection fraction; HFpEF; left ventricular expanders; mechanical circulatory support; neuromodulation; State-of-the-Art Review
• ISSN: 2452-302X; 2452-302X
• DOI: 10.1016/j.jacbts.2021.06.002

•The prevalence of heart failure with preserved ejection fraction among patients who present with symptoms of heart failure is approximately 50%.•Pharmacologic therapy has not conclusively shown benefits in morbidity and mortality in clinical trials.•Although it represents an active area of research, no device-based therapy has received regulatory approval for the treatment of heart failure with preserved ejection fraction.•Approaches such as atrial shunts, left ventricular expanders, mechanical circulatory support devices, and neurostimulators are at various stages of development. [Display omitted] Characterized by a rapidly increasing prevalence, elevated mortality and rehospitalization rates, and inadequacy of pharmaceutical therapies, heart failure with preserved ejection fraction (HFpEF) has motivated the widespread development of device-based solutions. HFpEF is a multifactorial disease of various etiologies and phenotypes, distinguished by diminished ventricular compliance, diastolic dysfunction, and symptoms of heart failure despite a normal ejection performance; these symptoms include pulmonary hypertension, limited cardiac reserve, autonomic imbalance, and exercise intolerance. Several types of atrial shunts, left ventricular expanders, stimulation-based therapies, and mechanical circulatory support devices are currently under development aiming to target one or more of these symptoms by addressing the associated mechanical or hemodynamic hallmarks. Although the majority of these solutions have shown promising results in clinical or preclinical studies, no device-based therapy has yet been approved for the treatment of patients with HFpEF. The purpose of this review is to discuss the rationale behind each of these devices and the findings from the initial testing phases, as well as the limitations and challenges associated with their clinical translation.