HFpEF

What is HFpEF? In heart failure with preserved ejection fraction (HFpEF), the heart pumps well but struggles to relax and fill with blood between beats. This raises the pressure inside the heart, especially during physical activity, causing symptoms like shortness of breath and fatigue - even with light activities like walking or climbing stairs. What is this study about? Recent research suggests that a higher heart rate may help lower this elevated pressure. Many HFpEF patients already have a pacemaker. This study investigates whether simply increasing the pacemaker rate during light exercise can reduce the pressure in the heart. How does the study work? We wille measure heart pressures in 20 patients in rest and while cycling using a heart catheter and monitor their breathing. Throughout these measurements, we will gradually increase the pacemaker rate step by step. Why does this matter? If a higher pacemaker rate successfully lowers heart pressure, this could offer a simple, drug-free way to improve daily functioning and comfort for thousands of patients with HFpEF, justifying further long-term studies to evaluate effects beyond the immediate changes in heart pressures.

Patients with advanced heart failure with preserved ejection fraction (HFpEF) will be randomly assigned in open-label multicenter study to receive triple combination therapy with \[angiotensin receptor/neprilysin inhibitor \[ARNI\] + sodium-glucose cotransporter 2 inhibitor \[SGLTi\] + mineralocorticoid receptor antagonist \[MRA\]) or with individualized medical therapy \[SGLTi + renin-angiotensin system inhibitor \[RASi\] \[angiotensin receptor blocker \[ARB\] or angiotensin-converting enzyme inhibitor \[ACE-I\]), and will be treated for 52 weeks

Heart failure with preserved ejection (HFpEF) disproportionately affects Veterans and is the number one reason for hospital discharge in the VA Health Care System. Exercise intolerance is a common complication experienced by patients with HFpEF, perpetuating physical inactivity and accelerating disease progression. This research proposal aims to elucidate mechanisms responsible for inadequate skeletal muscle blood flow and exercise intolerance in patients with HFpEF compared with healthy controls as well as following 8 weeks of exercise training in patients with HFpEF only.

Patients with HFpEF who have undergone meticulous clinical and instrumental evaluation (including diastolic exercise testing) between 2013 and 2020, will be followed up for at least 3 years.

This clinical trial will evaluate whether combination therapy with Dapagliflozin + Macitentan improves outcomes compared to Dapagliflozin + placebo in patients with combined pre- and post-capillary pulmonary hypertension (CpcPH). The study will measure changes in pulmonary vascular resistance, NT-proBNP, 6-minute walk distance, and quality of life (KCCQ scores) over 24 weeks. Participants will be randomly assigned to one of two groups, take study medication for 24 weeks, and undergo regular clinical, laboratory, and safety assessments.