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Treating heart failure with preserved ejection fraction: learning from pulmonary fibrosis
Author(s) -
Graziani Francesca,
Varone Francesco,
Crea Filippo,
Richeldi Luca
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1286
Subject(s) - medicine , pirfenidone , heart failure , fibrosis , pulmonary fibrosis , heart failure with preserved ejection fraction , cardiology , ejection fraction , cardiac fibrosis , idiopathic pulmonary fibrosis , pulmonary hypertension , lung
Heart failure with preserved ejection fraction (HFpEF) has a poor prognosis, and an effective treatment is currently lacking. Increasing evidence suggests a prevailing pathogenic role of cardiac fibrosis in HFpEF, which generates the possibility of a mechanistic overlap with pulmonary fibrosis. Indeed, cardiac and pulmonary fibrosis share some characteristics and molecular pathways, such as that of transforming growth factor‐β. If pulmonary and cardiac fibrosis share common pathways, we can hypothesize a beneficial effect of anti‐fibrotic drugs used in idiopathic pulmonary fibrosis on cardiac outcomes. Of note, pirfenidone has been tested in animal models of cardiac fibrosis and was found to be effective in reducing ventricular remodelling. Yet, no results are hitherto available for humans. In this review article, we discuss the potential benefit of anti‐fibrotic treatment in HFpEF. In particular, we propose to reappraise safety data collected in placebo‐controlled trials of anti‐fibrotic drugs in idiopathic pulmonary fibrosis, to explore the hypothesis that these might reduce cardiac fibrosis.