Roughly 3 million Americans are living with a form of heart failure that is easy to miss in its early stages and hard to treat later on—with doctors still working out why some people develop it while others with the same risk factors do not. Researchers behind a new study finally have some answers. The condition, known as heart failure with preserved ejection fraction, or HFpEF, occurs when the walls of the heart's left ventricle stiffen and thicken, leaving the heart unable to pump enough blood for everyday activity.
It is more common in women than men, and cases are rising. More than 80 percent of HFpEF patients also develop pulmonary hypertension, or high blood pressure in the blood vessels of the lungs, a combination known as PH-HFpEF. Several recent clinical trials aimed at treating the condition have failed, leaving doctors with few effective options.
A study published in Circulation: Heart Failure, led by researchers at the University of Wisconsin–Madison and the Morgridge Institute for Research, offers new tools for identifying which patients face the greatest danger. "HFpEF is a disease of the aging heart, where the heart becomes stiff and pressure backs up into the lungs, leaving patients severely breathless," Farhan Raza, a cardiologist at the University of Wisconsin–Madison's Cardiovascular Research Center and the study's lead author, told Newsweek. "Yet we still have no effective ways to treat these high lung pressures." "Right now, it's a bit like navigating a vast ocean without a map," he continued.
"Our study is an early step toward building that map, pinpointing where the lung circulation is going wrong so we can ultimately target treatments to the right problem in the right patient." The researchers examined 48 PH-HFpEF patients who underwent detailed cardiac testing, including invasive procedures and cardiac MRIs. Of these, 29 had normal function in the heart's right ventricle, which pumps blood to the lungs, while 19 showed signs of dysfunction. Patients with right ventricle dysfunction had significantly higher rates of death and hospitalization, the team found.
Right ventricle function proved to be a stronger predictor of patient outcomes than other measures doctors use to gauge disease severity. The study also suggests that problems originating in the left side of the heart can place stress on the right ventricle, contributing to its decline. "HFpEF is incredibly common," Raza said in a statement.
"Many patients feel profoundly breathless and have dramatically poor quality of life from this disease." "A big challenge is that we don't know why some people develop HFpEF who have the same medical problems of obesity, hypertension and diabetes, and why some people don't, and sometimes we recognize it too late and they've already developed damage to other parts of their body." Additional biopsies of heart tissue pointed to weakened mitochondria, the energy-producing structures within cells, as a likely contributor to the disease. The team also found increased activity in RNA metabolism, a process that helps cells build proteins, reinforcing earlier research linking both processes to heart disease. Using long-read RNA sequencing technology, researchers identified several genes expressed differently in patients with right ventricle dysfunction, including one called GATD3.
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