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Review Article| Volume 29, ISSUE 3, P375-388, March 2023

Epidemiology, Pathophysiology, Diagnosis, and Therapy of Heart Failure With Preserved Ejection Fraction in Japan

      Highlights

      • The prevalence of HFpEF in Japan is increasing, due primarily to population aging.
      • Phenotypical differences may exist between Japanese HFpEF and Western populations.
      • Characterization of Japanese HFpEF may provide new therapy specific to this cohort.

      ABSTRACT

      Heart failure (HF) with preserved ejection fraction (HFpEF) is a global health care problem, with diagnostic difficulty, limited treatment options and high morbidity and mortality rates. The prevalence of HFpEF is increasing because of the aging population and the increasing burden of cardiac and metabolic comorbidities, such as systemic hypertension, diabetes, chronic kidney disease, and obesity. The knowledge base is derived primarily from the United States and Europe, and data from Asian countries, including Japan, remain limited. Given that phenotypic differences may exist between Japanese and Western patients with HFpEF, careful characterization may hold promise to deliver new therapy specific to the Japanese population. In this review, we summarize the current knowledge regarding the epidemiology, pathophysiology and diagnosis of and the potential therapies for HFpEF in Japan.

      Key Words

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      References

        • Virani SS
        • Alonso A
        • Aparicio HJ
        • Benjamin EJ
        • Bittencourt MS
        • Callaway CW
        • et al.
        Heart Disease and Stroke Statistics: 2021 Update: a report from the American Heart Association.
        Circulation. 2021; 143: e254-e743https://doi.org/10.1161/CIR.0000000000000950
        • Borlaug BA.
        Evaluation and management of heart failure with preserved ejection fraction.
        Nat Rev Cardiol. 2020; 17: 559-573https://doi.org/10.1038/s41569-020-0363-2
        • Lam CSP
        • Voors AA
        • De Boer RA
        • Solomon SD
        • Van Veldhuisen DJ
        Heart failure with preserved ejection fraction: From mechanisms to therapies.
        Eur Heart J. 2018; 39: 2780-2792https://doi.org/10.1093/eurheartj/ehy301
        • Beard JR
        • Officer A
        • de Carvalho IA
        • Sadana R
        • Pot AM
        • Michel J-P
        • et al.
        The world report on ageing and health: a policy framework for healthy ageing.
        Lancet. 2016; 387: 2145-2154https://doi.org/10.1016/S0140-6736(15)00516-4
        • Cabinet Office
        Government of Japan. Report on Aging Society. 2021; (n.d)
      1. United Nations: Department of Economic and Social. World Population Ageing, 2019.

        • Shiba N
        • Nochioka K
        • Miura M
        • Kohno H
        • Shimokawa H
        CHART-2 Investigators. Trend of Westernization of etiology and clinical characteristics of heart failure patients in Japan: first report from the CHART-2 study.
        Circ J. 2011; 75: 823-833https://doi.org/10.1253/circj.cj-11-0135
        • Okura Y
        • Ramadan MM
        • Ohno Y
        • Mitsuma W
        • Tanaka K
        • Ito M
        • et al.
        Impending epidemic: future projection of heart failure in Japan to the year 2055.
        Circ J. 2008; 72: 489-491https://doi.org/10.1253/circj.72.489
        • Tromp J
        • Teng T-H
        • Tay WT
        • Hung CL
        • Narasimhan C
        • Shimizu W
        • et al.
        Heart failure with preserved ejection fraction in Asia.
        Eur J Heart Fail. 2019; 21: 23-36https://doi.org/10.1002/ejhf.1227
        • Bluemke DA
        • Butler J
        • Frcp C
        • Pham M
        • Piña IL
        • Justin G
        Forecasting the impact of heart failure in the United States.
        Circ Heart Fail. 2014; 6: 606-619https://doi.org/10.1161/HHF.0b013e318291329a
        • Yasuda S
        • Miyamoto Y
        • Ogawa H.
        Current status of cardiovascular medicine in the aging society of Japan.
        Circulation. 2018; 138: 965-967https://doi.org/10.1161/CIRCULATIONAHA.118.035858
        • Yamamoto S
        • Yamasaki S
        • Higuchi S
        • Kamiya K
        • Saito H
        • Saito K
        • et al.
        Prevalence and prognostic impact of cognitive frailty in elderly patients with heart failure: sub-analysis of FRAGILE-HF.
        ESC Heart Fail. 2022; 9: 1574-1583https://doi.org/10.1002/ehf2.13844
        • Ide T
        • Kaku H
        • Matsushima S
        • Tohyama T
        • Enzan N
        • Funakoshi K
        • et al.
        Clinical characteristics and outcomes of hospitalized patients with heart failure from the large-scale Japanese Registry Of Acute Decompensated Heart Failure (JROADHF).
        Circ J. 2021; 85: 1438-1450https://doi.org/10.1253/circj.CJ-20-0947
        • Ogawa S
        • Nagatomo Y
        • Takei M
        • Saji M
        • Goda A
        • Kohno T
        • et al.
        Impact of left ventricular chamber size on outcome in heart failure with preserved ejection fraction.
        Int Heart J. 2022; 63: 62-72https://doi.org/10.1536/ihj.21-486
        • Yaku H
        • Ozasa N
        • Morimoto T
        • Inuzuka Y
        • Tamaki Y
        • Yamamoto E
        • et al.
        Demographics, management, and in-hospital outcome of hospitalized acute heart failure syndrome patients in contemporary real clinical practice in Japan: observations from the prospective, multicenter Kyoto Congestive Heart Failure (KCHF) registry.
        Circ J. 2018; 82: 2811-2819https://doi.org/10.1253/circj.CJ-17-1386
        • Tsuchihashi-Makaya M
        • Hamaguchi S
        • Kinugawa S
        • Yokota T
        • Goto D
        • Yokoshiki H
        • et al.
        Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction: report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD).
        Circ J. 2009; 73: 1893-1900https://doi.org/10.1253/circj.cj-09-0254
        • Tsuji K
        • Sakata Y
        • Nochioka K
        • Miura M
        • Yamauchi T
        • Onose T
        • et al.
        Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study.
        Eur J Heart Fail. 2017; 19: 1258-1269https://doi.org/10.1002/ejhf.807
        • Shiga T
        • Suzuki A
        • Haruta S
        • Mori F
        • Ota Y
        • Yagi M
        • et al.
        Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan.
        ESC Heart Fail. 2019; 6: 475-486https://doi.org/10.1002/ehf2.12418
        • Ueda T
        • Kawakami R
        • Nakada Y
        • Nakano T
        • Nakagawa H
        • Matsui M
        • et al.
        Differences in blood pressure riser pattern in patients with acute heart failure with reduced mid-range and preserved ejection fraction.
        ESC Heart Fail. 2019; 6: 1057-1067https://doi.org/10.1002/ehf2.12500
        • Yamamoto M
        • Seo Y
        • Ishizu T
        • Nishi I
        • Hamada-Harimura Y
        • Machino-Ohtsuka T
        • et al.
        Different impact of changes in left ventricular ejection fraction between heart failure classifications in patients with acute decompensated heart failure.
        Circ J. 2019; 83: 584-594https://doi.org/10.1253/circj.CJ-18-0881
        • Tokitsu T
        • Yamamoto E
        • Hirata Y
        • Kusaka H
        • Fujisue K
        • Sueta D
        • et al.
        Clinical significance of pulse pressure in patients with heart failure with preserved left ventricular ejection fraction.
        Eur J Heart Fail. 2016; 18: 1353-1361https://doi.org/10.1002/ejhf.559
        • Suzuki S
        • Motoki H
        • Kanzaki Y
        • Maruyama T
        • Hashizume N
        • Kozuka A
        • et al.
        Prognostic impact of mineralocorticoid receptor antagonist in patients with heart failure with preserved ejection fraction.
        ESC Heart Fail. 2020; 7: 2752-2761https://doi.org/10.1002/ehf2.12867
        • Hamada T
        • Kubo T
        • Kawai K
        • Nakaoka Y
        • Yabe T
        • Furuno T
        • et al.
        Clinical characteristics and frailty status in heart failure with preserved vs. reduced ejection fraction.
        ESC Heart Fail. 2022; 9: 1853-1863https://doi.org/10.1002/ehf2.13885
        • Odajima S
        • Tanaka H
        • Fujimoto W
        • Kuroda K
        • Yamashita S
        • Imanishi J
        • et al.
        Efficacy of renin-angiotensin-aldosterone-system inhibitors for heart failure with preserved ejection fraction and left ventricular hypertrophy: from the KUNIUMI Registry Acute Cohort.
        J Cardiol. 2022; 79: 703-710https://doi.org/10.1016/j.jjcc.2021.12.002
        • Chandramouli C
        • Ting W
        • Id T
        • Bamadhaj NS
        • Tromp J
        • Teng TK
        • et al.
        Association of obesity with heart failure outcomes in 11 Asian regions: a cohort study.
        PLos Med. 2019; 16e1002916
      2. Ministry of Health, Labour and Welfare of Japan. National Health and Nutrition Survey Report 2019. n.d.

        • Rao VN
        • Zhao D
        • Allison MA
        • Guallar E
        • Sharma K
        • Criqui MH
        • et al.
        Adiposity and incident heart failure and its subtypes.
        JACC Heart Fail. 2018; 6: 942https://doi.org/10.1016/j.jchf.2018.07.009
        • Harada T
        • Obokata M.
        Obesity-related heart failure with preserved ejection fraction.
        Heart Fail Clin. 2020; 16: 357-368https://doi.org/10.1016/j.hfc.2020.02.004
        • Sorimachi H
        • Omote K
        • Borlaug BA.
        Clinical phenogroups in heart failure with preserved ejection fraction.
        Heart Fail Clin. 2021; 17: 483-498https://doi.org/10.1016/j.hfc.2021.02.009
        • Obokata M
        • Reddy YNV
        • Pislaru SV.
        • Melenovsky V
        • Borlaug BA.
        Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction.
        Circulation. 2017; 136: 6-19https://doi.org/10.1161/CIRCULATIONAHA.116.026807
        • Reddy YNV
        • Lewis GD
        • Shah SJ
        • Obokata M
        • Abou-Ezzedine OF
        • Fudim M
        • et al.
        Characterization of the obese phenotype of heart failure with preserved ejection fraction: a RELAX trial ancillary study.
        Mayo Clin Proc. 2019; 94: 1199-1209https://doi.org/10.1016/j.mayocp.2018.11.037
        • Koepp KE
        • Obokata M
        • Reddy YNV
        • Olson TP
        • Borlaug BA.
        Hemodynamic and functional impact of epicardial adipose tissue in heart failure with preserved ejection fraction.
        JACC Heart Fail. 2020; 8: 657-666https://doi.org/10.1016/j.jchf.2020.04.016
        • Sorimachi H
        • Burkhoff D
        • Verbrugge FH
        • Omote K
        • Obokata M
        • Reddy YNV
        • et al.
        Obesity, venous capacitance, and venous compliance in heart failure with preserved ejection fraction.
        Eur J Heart Fail. 2021; 23: 1648-1658https://doi.org/10.1002/ejhf.2254
        • Paulus WJ
        • Tschöpe C.
        A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation.
        J Am Coll Cardiol. 2013; 62: 263-271https://doi.org/10.1016/j.jacc.2013.02.092
        • Schiattarella GG
        • Rodolico D
        • Hill JA.
        Metabolic inflammation in heart failure with preserved ejection fraction.
        Cardiovasc Res. 2021; 117: 423-434https://doi.org/10.1093/cvr/cvaa217
        • Sorimachi H
        • Obokata M
        • Takahashi N
        • Reddy YN V
        • Jain CC
        • Verbrugge FH
        • et al.
        Pathophysiologic importance of visceral adipose tissue in women with heart failure and preserved ejection fraction.
        Eur Heart J. 2021; 42: 1595-1605https://doi.org/10.1093/eurheartj/ehaa823
        • Kadowaki S
        • Miura K
        • Kadowaki T
        • Fujiyoshi A
        • El-Saed A
        • Masaki KH
        • et al.
        International comparison of abdominal fat distribution among four populations: The ERA-JUMP study.
        Metab Syndr Relat Disord. 2018; 16: 166-173https://doi.org/10.1089/met.2017.0132
        • Harada T
        • Sunaga H
        • Sorimachi H
        • Yoshida K
        • Kato T
        • Kurosawa K
        • et al.
        Pathophysiological role of fatty acid-binding protein 4 in Asian patients with heart failure and preserved ejection fraction.
        ESC Heart Fail. 2020; 7: 4256-4266https://doi.org/10.1002/ehf2.13071
        • Sunaga A
        • Hikoso S
        • Yamada T
        • Yasumura Y
        • Uematsu M
        • Abe H
        • et al.
        Abdominal obesity, and not general obesity, is associated with a lower 123I MIBG heart-to-mediastinum ratio in heart failure patients with preserved ejection fraction.
        Eur J Nucl Med Mol Imaging. 2022; 49: 609-618https://doi.org/10.1007/s00259-021-05280-9
        • Bank IEM
        • Gijsberts CM
        • Teng THK
        • Benson L
        • Sim D
        • Yeo PSD
        • et al.
        Prevalence and clinical significance of diabetes in Asian versus white patients with heart failure.
        JACC Heart Fail. 2017; 5: 14-24https://doi.org/10.1016/j.jchf.2016.09.015
        • Kim DS
        • Kim BC
        • Daily JW
        • Park S.
        High genetic risk scores for impaired insulin secretory capacity doubles the risk for type 2 diabetes in Asians and is exacerbated by Western-type diets.
        Diabetes Metab Res Rev. 2018; 34https://doi.org/10.1002/dmrr.2944
        • Yap J
        • Tay WT
        • Teng T-HK
        • Anand I
        • Richards AM
        • Ling LH
        • et al.
        Association of diabetes mellitus on cardiac remodeling, quality of life, and clinical outcomes in heart failure with reduced and preserved ejection fraction.
        J Am Heart Assoc. 2019; 8e013114https://doi.org/10.1161/JAHA.119.013114
        • Lindman BR
        • Dávila-Román VG
        • Mann DL
        • McNulty S
        • Semigran MJ
        • Lewis GD
        • et al.
        Cardiovascular phenotype in HFpEF patients with or without diabetes: a RELAX trial ancillary study.
        J Am Coll Cardiol. 2014; 64: 541-549https://doi.org/10.1016/j.jacc.2014.05.030
        • Paulus WJ
        • Dal Canto E
        Distinct myocardial targets for diabetes therapy in heart failure with preserved or reduced ejection fraction.
        JACC Heart Fail. 2018; 6: 1-7https://doi.org/10.1016/j.jchf.2017.07.012
        • Boodhwani M
        • Sodha NR
        • Mieno S
        • Xu S-H
        • Feng J
        • Ramlawi B
        • et al.
        Functional, cellular, and molecular characterization of the angiogenic response to chronic myocardial ischemia in diabetes.
        Circulation. 2007; 116: I31-I37https://doi.org/10.1161/CIRCULATIONAHA.106.680157
        • Obokata M
        • Reddy YNV
        • Melenovsky V
        • Kane GC
        • Olson TP
        • Jarolim P
        • et al.
        Myocardial injury and cardiac reserve in patients with heart failure and preserved ejection fraction.
        J Am Coll Cardiol. 2018; 72: 29-40https://doi.org/10.1016/j.jacc.2018.04.039
        • Ando H
        • Yamaji K
        • Kohsaka S
        • Ishii H
        • Wada H
        • Yamada S
        • et al.
        Japanese nationwide PCI (J-PCI) Registry Annual Report 2019: patient demographics and in-hospital outcomes.
        Cardiovasc Interv Ther. 2022; 37: 243-247https://doi.org/10.1007/s12928-021-00832-0
        • Sarnak MJ
        • Amann K
        • Bangalore S
        • Cavalcante JL
        • Charytan DM
        • Craig JC
        • et al.
        Chronic kidney disease and coronary artery disease: JACC state-of-the-art review.
        J Am Coll Cardiol. 2019; 74: 1823-1838https://doi.org/10.1016/j.jacc.2019.08.1017
        • Yamanaka S
        • Sakata Y
        • Nochioka K
        • Miura M
        • Kasahara S
        • Sato M
        • et al.
        Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction.
        Eur J Heart Fail. 2020; 22: 2258-2268https://doi.org/10.1002/ejhf.1945
        • Kato S
        • Fukui K
        • Kodama S
        • Azuma M
        • Nakayama N
        • Iwasawa T
        • et al.
        Cardiovascular magnetic resonance assessment of coronary flow reserve improves risk stratification in heart failure with preserved ejection fraction.
        J Cardiovasc Magn Reson. 2021; 23: 112https://doi.org/10.1186/s12968-021-00807-3
        • Matsue Y
        • Kamiya K
        • Saito H
        • Saito K
        • Ogasahara Y
        • Maekawa E
        • et al.
        Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study.
        Eur J Heart Fail. 2020; 22: 2112-2119https://doi.org/10.1002/ejhf.1926
        • Sunaga A
        • Hikoso S
        • Yamada T
        • Yasumura Y
        • Uematsu M
        • Tamaki S
        • et al.
        Prognostic impact of Clinical Frailty Scale in patients with heart failure with preserved ejection fraction.
        ESC Heart Fail. 2021; 8: 3316-3326https://doi.org/10.1002/ehf2.13482
        • Warraich HJ
        • Kitzman DW
        • Whellan DJ
        • Duncan PW
        • Mentz RJ
        • Pastva AM
        • et al.
        Physical function, frailty, cognition, depression, and quality of life in hospitalized adults ≥60 years with acute decompensated heart failure with preserved versus reduced ejection fraction.
        Circ Heart Fail. 2018; 11e005254https://doi.org/10.1161/CIRCHEARTFAILURE.118.005254
        • Dhakal BP
        • Malhotra R
        • Murphy RM
        • Pappagianopoulos PP
        • Baggish AL
        • Weiner RB
        • et al.
        Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction.
        Circ Heart Fail. 2015; 8: 286-294https://doi.org/10.1161/CIRCHEARTFAILURE.114.001825
        • Tomczak CR
        • Thompson RB
        • Paterson I
        • Schulte F
        • Cheng-Baron J
        • Haennel RG
        • et al.
        Effect of acute high-intensity interval exercise on postexercise biventricular function in mild heart failure.
        J Appl Physiol. 2011; 110: 398-406https://doi.org/10.1152/japplphysiol.01114.2010
        • Zakeri R
        • Chamberlain AM
        • Roger VL
        • Redfield MM.
        Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study.
        Circulation. 2013; 128: 1085-1093https://doi.org/10.1161/CIRCULATIONAHA.113.001475
        • Reddy YN V
        • Obokata M
        • Gersh BJ
        • Chb MB
        • Borlaug BA
        • Letter R.
        High prevalence of occult heart failure with preserved ejection fraction among patients with atrial fibrillation and dyspnea.
        Circulation. 2018; 137: 534-535https://doi.org/10.1161/CIRCULATIONAHA.117.030093
        • Obokata M
        • Reddy YNV
        • Melenovsky V
        • Pislaru S
        • Borlaug BA.
        Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction.
        Eur Heart J. 2019; 40: 689-698https://doi.org/10.1093/eurheartj/ehy809
        • Reddy YN V
        • Obokata M
        • Verbrugge FH
        • Lin G
        • Borlaug BA.
        Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation.
        J Am Coll Cardiol. 2020; 76: 1051-1064https://doi.org/10.1016/j.jacc.2020.07.009
        • Ikoma T
        • Obokata M
        • Okada K
        • Harada T
        • Sorimachi H
        • Yoshida K
        • et al.
        Impact of right atrial remodeling in heart failure with preserved ejection fraction.
        J Card Fail. 2021; 27: 577-584https://doi.org/10.1016/j.cardfail.2020.12.016
        • Zakeri R
        • Borlaug BA
        • Mcnulty SE
        • Mohammed SF
        • Lewis GD
        • Semigran MJ
        • et al.
        Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: A RELAX Trial ancillary study.
        Circ Heart Fail. 2014; 7: 123-130https://doi.org/10.1161/CIRCHEARTFAILURE.113.000568
        • Gorter TM
        • van Melle JP
        • Rienstra M
        • Borlaug BA
        • Hummel YM
        • van Gelder IC
        • et al.
        Right heart dysfunction in heart failure with preserved ejection fraction: the impact of atrial fibrillation.
        J Card Fail. 2018; 24: 177-185https://doi.org/10.1016/j.cardfail.2017.11.005
        • Tan ESJ
        • Goh V
        • Santema BT
        • Tay WT
        • Teng T-HK
        • Yap J
        • et al.
        Ethnic differences in atrial fibrillation among patients with heart failure in Asia.
        ESC Heart Fail. 2020; 7: 1419-1429https://doi.org/10.1002/ehf2.12696
        • Nakagawa A
        • Yasumura Y
        • Yoshida C
        • Okumura T
        • Tateishi J
        • Yoshida J
        • et al.
        Prognostic importance of right ventricular-vascular uncoupling in acute decompensated heart failure with preserved ejection fraction.
        Circ Cardiovasc Imaging. 2020; 13e011430https://doi.org/10.1161/CIRCIMAGING.120.011430
        • Tamargo M
        • Obokata M
        • Reddy YNV
        • Pislaru SV
        • Lin G
        • Egbe AC
        • et al.
        Functional mitral regurgitation and left atrial myopathy in heart failure with preserved ejection fraction.
        Eur J Heart Fail. 2020; 22: 489-498https://doi.org/10.1002/ejhf.1699
        • Reddy YNV
        • Obokata M
        • Egbe A
        • Yang JH
        • Pislaru S
        • Lin G
        • et al.
        Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction.
        Eur J Heart Fail. 2019; 21: 891-900https://doi.org/10.1002/ejhf.1464
        • Obokata M
        • Negishi K
        • Kurosawa K
        • Arima H
        • Tateno R
        • Ui G
        • et al.
        Incremental diagnostic value of la strain with leg lifts in heart failure with preserved ejection fraction.
        JACC Cardiovasc Imaging. 2013; 6: 749-758https://doi.org/10.1016/j.jcmg.2013.04.006
        • Obokata M
        • Kane GC
        • Reddy YNV
        • Olson TP
        • Melenovsky V
        • Borlaug BA.
        Role of diastolic stress testing in the evaluation for heart failure with preserved ejection fraction: a simultaneous invasive-echocardiographic study.
        Circulation. 2017; 135: 825-838https://doi.org/10.1161/CIRCULATIONAHA.116.024822
        • Obokata M
        • Reddy YN V
        The role of echocardiography in heart failure with preserved ejection fraction: what do we want from imaging?.
        Heart Fail Clin. 2019; 15: 241-256https://doi.org/10.1016/j.hfc.2018.12.004
        • Harada T
        • Kagami K
        • Kato T
        • Obokata M.
        Echocardiography in the diagnostic evaluation and phenotyping of heart failure with preserved ejection fraction.
        J Cardiol. 2022; 79: 679-690https://doi.org/10.1016/j.jjcc.2021.11.003
        • Reddy YNV
        • Carter RE
        • Obokata M
        • Redfield MM
        • simple Borlaug BA.A
        evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction.
        Circulation. 2018; 138: 861-870https://doi.org/10.1161/CIRCULATIONAHA.118.034646
        • Obokata M
        • Olson TP
        • Reddy YN V
        • Melenovsky V
        • Kane GC
        • Borlaug BA.
        Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction.
        Eur Heart J. 2018; 39: 2810-2821https://doi.org/10.1093/eurheartj/ehy268
        • Obokata M
        • Reddy YN V
        • Koepp KE
        • Stewart GM
        • Olson TP
        • Melenovsky V
        • et al.
        Salutary acute effects of exercise on central hemodynamics in heart failure with preserved ejection fraction.
        J Card Fail. 2021; 27: 1313-1320https://doi.org/10.1016/j.cardfail.2021.04.014
        • Pieske B
        • Tschöpe C
        • De Boer RA
        • Fraser AG
        • Anker SD
        • Donal E
        • et al.
        How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).
        Eur Heart J. 2019; 40: 3297-3317https://doi.org/10.1093/eurheartj/ehz641
        • Selvaraj S
        • Myhre PL
        • Vaduganathan M
        • Claggett BL
        • Matsushita K
        • Kitzman DW
        • et al.
        Application of diagnostic algorithms for heart failure with preserved ejection fraction to the community.
        JACC Heart Fail. 2020; 8: 640-653https://doi.org/10.1016/j.jchf.2020.03.013
        • Tada A
        • Nagai T
        • Omote K
        • Iwano H
        • Tsujinaga S
        • Kamiya K
        • et al.
        Performance of the H2FPEF and the HFA-PEFF scores for the diagnosis of heart failure with preserved ejection fraction in Japanese patients: a report from the Japanese multicenter registry.
        Int J Cardiol. 2021; 342: 43-48https://doi.org/10.1016/j.ijcard.2021.08.001
        • Seo Y
        • Ishizu T
        • Ieda M
        • Ohte N
        • Study Investigators J-LONG
        Clinical usefulness of the HFA-PEFF diagnostic scoring system in identifying late elderly heart failure with preserved ejection fraction patients.
        Circ J. 2021; 85: 604-611https://doi.org/10.1253/circj.CJ-20-0784
        • Hahn VS
        • Yanek LR
        • Vaishnav J
        • Ying W
        • Vaidya D
        • Lee YZJ
        • et al.
        Endomyocardial biopsy characterization of heart failure with preserved ejection fraction and prevalence of cardiac amyloidosis.
        JACC Heart Fail. 2020; 8: 712-724https://doi.org/10.1016/j.jchf.2020.04.007
        • González-López E
        • Gallego-Delgado M
        • Guzzo-Merello G
        • de Haro-del Moral FJ
        • Cobo-Marcos M
        • Robles C
        • et al.
        Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction.
        Eur Heart J. 2015; 36: 2585-2594https://doi.org/10.1093/eurheartj/ehv338
        • Schmidt HH
        • Waddington-Cruz M
        • Botteman MF
        • Carter JA
        • Chopra AS
        • Hopps M
        • et al.
        Estimating the global prevalence of transthyretin familial amyloid polyneuropathy.
        Muscle Nerve. 2018; 57: 829-837https://doi.org/10.1002/mus.26034
        • Ueda M
        • Horibata Y
        • Shono M
        • Misumi Y
        • Oshima T
        • Su Y
        • et al.
        Clinicopathological features of senile systemic amyloidosis: an ante- and post-mortem study.
        Mod Pathol. 2011; 24: 1533-1544https://doi.org/10.1038/modpathol.2011.117
        • Inomata T
        • Tahara N
        • Nakamura K
        • Endo J
        • Ueda M
        • Ishii T
        • et al.
        Diagnosis of wild-type transthyretin amyloid cardiomyopathy in Japan: red-flag symptom clusters and diagnostic algorithm.
        ESC Heart Fail. 2021; 8: 2647-2659https://doi.org/10.1002/ehf2.13473
        • Yamada T
        • Takashio S
        • Arima Y
        • Nishi M
        • Morioka M
        • Hirakawa K
        • et al.
        Clinical characteristics and natural history of wild-type transthyretin amyloid cardiomyopathy in Japan.
        ESC Heart Fail. 2020; 7: 2829-2837https://doi.org/10.1002/ehf2.12884
        • Grogan M
        • Scott CG
        • Kyle RA
        • Zeldenrust SR
        • Gertz MA
        • Lin G
        • et al.
        Natural history of wild-type transthyretin cardiac amyloidosis and risk stratificationusing a novel staging system.
        J Am Coll Cardiol. 2016; 68: 1014-1020https://doi.org/10.1016/j.jacc.2016.06.033
        • Connors LH
        • Sam F
        • Skinner M
        • Salinaro F
        • Sun F
        • Ruberg FL
        • et al.
        Heart failure resulting from age-related cardiac amyloid disease associated with wild-type transthyretin: a prospective, observational cohort study.
        Circulation. 2016; 133: 282-290https://doi.org/10.1161/CIRCULATIONAHA.115.018852
        • Witteles RM
        • Bokhari S
        • Damy T
        • Elliott PM
        • Falk RH
        • Fine NM
        • et al.
        Screening for transthyretin amyloid cardiomyopathy in everyday practice.
        JACC Heart Fail. 2019; 7: 709-716https://doi.org/10.1016/j.jchf.2019.04.010
        • Tsutsui H
        • Ide T
        • Ito H
        • Kihara Y
        • Kinugawa K
        • Kinugawa S
        • et al.
        JCS/JHFS 2021 Guideline-focused update on diagnosis and treatment of acute and chronic heart failure.
        J Card Fail. 2021; 27: 1404-1444https://doi.org/10.1016/j.cardfail.2021.04.023
        • Heidenreich PA
        • Bozkurt B
        • Aguilar D
        • Allen LA
        • Byun JJ
        • Colvin MM
        • et al.
        2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2022; 145: e895-1032https://doi.org/10.1161/CIR.0000000000001063
        • Anker SD
        • Butler J
        • Filippatos G
        • Ferreira JP
        • Bocchi E
        • Böhm M
        • et al.
        Empagliflozin in heart failure with a preserved ejection fraction.
        N Engl J Med. 2021; 385: 1451-1461https://doi.org/10.1056/NEJMoa2107038
        • Tsutsui H
        • Isobe M
        • Ito H
        • Ito H
        • Okumura K
        • Ono M
        • et al.
        JCS 2017/JHFS 2017 Guideline on diagnosis and treatment of acute and chronic heart failure: digest version.
        Circ J. 2019; 83: 2084-2184https://doi.org/10.1253/circj.CJ-19-0342
        • Imamura T
        • Tolvaptan Kinugawa K.
        Improves the long-term prognosis in patients with congestive heart failure with preserved ejection fraction as well as in those with reduced ejection fraction.
        Int Heart J. 2016; 57: 600-606https://doi.org/10.1536/ihj.16-023
        • Pfeffer MA
        • Claggett B
        • Assmann SF
        • Boineau R
        • Anand IS
        • Clausell N
        • et al.
        Regional variation in patients and outcomes in the treatment of preserved cardiac function heart failure with an aldosterone antagonist (TOPCAT) trial.
        Circulation. 2015; 131: 34-42https://doi.org/10.1161/CIRCULATIONAHA.114.013255
        • Nishino M
        • Yano M
        • Ukita K
        • Kawamura A
        • Nakamura H
        • Matsuhiro Y
        • et al.
        Impact of readmissions on octogenarians with heart failure with preserved ejection fraction: PURSUIT-HFpEF registry.
        ESC Hear Fail. 2021; 8: 2120-2132https://doi.org/10.1002/ehf2.13293
        • Obokata M
        • Reddy YNV
        • Borlaug BA.
        Diastolic dysfunction and heart failure with preserved ejection fraction: understanding mechanisms by using noninvasive methods.
        JACC Cardiovasc Imaging. 2020; 13: 245-257https://doi.org/10.1016/j.jcmg.2018.12.034
        • Kitzman DW
        • Brubaker P
        • Morgan T
        • Haykowsky M
        • Hundley G
        • Kraus WE
        • et al.
        Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial.
        JAMA. 2016; 315: 36-46https://doi.org/10.1001/jama.2015.17346
        • Solomon SD
        • McMurray JJV
        • Anand IS
        • Ge J
        • Lam CSP
        • Maggioni AP
        • et al.
        Angiotensin–neprilysin inhibition in heart failure with preserved ejection fraction.
        N Engl J Med. 2019; 381: 1609-1620https://doi.org/10.1056/nejmoa1908655
        • Shah SJ
        • Borlaug BA
        • Chung ES
        • Cutlip DE
        • Debonnaire P
        • Fail PS
        • et al.
        Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial.
        Lancet. 2022; 399: 1130-1140https://doi.org/10.1016/S0140-6736(22)00016-2
        • Shah SJ
        • Kitzman DW
        • Borlaug BA
        • Van Heerebeek L
        • Zile MR
        • Kass DA
        • et al.
        Phenotype-specific treatment of heart failure with preserved ejection fraction.
        Circulation. 2016; 134: 73-90https://doi.org/10.1161/CIRCULATIONAHA.116.021884
        • Shah SJ
        • Katz DH
        • Selvaraj S
        • Burke MA
        • Yancy CW
        • Gheorghiade M
        • et al.
        Phenomapping for novel classification of heart failure with preserved ejection fraction.
        Circulation. 2015; 131: 269-279https://doi.org/10.1161/CIRCULATIONAHA.114.010637
        • Cohen JB
        • Schrauben SJ
        • Zhao L
        • Basso MD
        • Cvijic ME
        • Li Z
        • et al.
        Clinical phenogroups in heart failure with preserved ejection fraction: detailed phenotypes, prognosis, and response to spironolactone.
        JACC Heart Fail. 2020; 8: 172-184https://doi.org/10.1016/j.jchf.2019.09.009
        • Reddy YNV
        • Rikhi A
        • Obokata M
        • Shah SJ
        • Lewis GD
        • AbouEzzedine OF
        • et al.
        Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity.
        Eur J Heart Fail. 2020; 22: 1009-1018https://doi.org/10.1002/ejhf.1788
        • Reddy YN V
        • Anantha-Narayanan M
        • Obokata M
        • Koepp KE
        • Erwin P
        • Carter RE
        • et al.
        Hemodynamic effects of weight loss in obesity: a systematic review and meta-analysis.
        JACC Heart Fail. 2019; 7: 678-687https://doi.org/10.1016/j.jchf.2019.04.019
        • Gepner Y
        • Shelef I
        • Schwarzfuchs D
        • Zelicha H
        • Tene L
        • Yaskolka Meir A
        • et al.
        Effect of distinct lifestyle interventions on mobilization of fat storage pools: CENTRAL magnetic resonance imaging randomized controlled trial.
        Circulation. 2018; 137: 1143-1157https://doi.org/10.1161/CIRCULATIONAHA.117.030501
        • Kurinami N
        • Sugiyama S
        • Yoshida A
        • Hieshima K
        • Miyamoto F
        • Kajiwara K
        • et al.
        Dapagliflozin significantly reduced liver fat accumulation associated with a decrease in abdominal subcutaneous fat in patients with inadequately controlled type 2 diabetes mellitus.
        Diabetes Res Clin Pract. 2018; 142: 254-263https://doi.org/10.1016/j.diabres.2018.05.017
        • Sato T
        • Aizawa Y
        • Yuasa S
        • Kishi S
        • Fuse K
        • Fujita S
        • et al.
        The effect of dapagliflozin treatment on epicardial adipose tissue volume.
        Cardiovasc Diabetol. 2018; 17: 6https://doi.org/10.1186/s12933-017-0658-8
        • Parisi V
        • Petraglia L
        • D'Esposito V
        • Cabaro S
        • Rengo G
        • Caruso A
        • et al.
        Statin therapy modulates thickness and inflammatory profile of human epicardial adipose tissue.
        Int J Cardiol. 2019; 274: 326-330https://doi.org/10.1016/j.ijcard.2018.06.106
        • Nochioka K
        • Sakata Y
        • Miyata S
        • Miura M
        • Takada T
        • Tadaki S
        • et al.
        Prognostic impact of statin use in patients with heart failure and preserved ejection fraction.
        Circ J. 2015; 79: 574-582https://doi.org/10.1253/circj.CJ-14-0865
        • Kamisaka K
        • Kamiya K
        • Iwatsu K
        • Iritani N
        • Imoto S
        • Adachi T
        • et al.
        Impact of weight loss in patients with heart failure with preserved ejection fraction: results from the FLAGSHIP study.
        ESC Heart Fail. 2021; 8: 5293-5303https://doi.org/10.1002/ehf2.13619
        • Matsuhiro Y
        • Nishino M
        • Ukita K
        • Kawamura A
        • Nakamura H
        • Yasumoto K
        • et al.
        Underweight is associated with poor prognosis in heart failure with preserved ejection fraction.
        Int Heart J. 2021; 62: 1042-1051https://doi.org/10.1536/ihj.21-195
        • Nishi I
        • Seo Y
        • Hamada-Harimura Y
        • Yamamoto M
        • Ishizu T
        • Sugano A
        • et al.
        Geriatric nutritional risk index predicts all-cause deaths in heart failure with preserved ejection fraction.
        ESC Heart Fail. 2019; 6: 396-405https://doi.org/10.1002/ehf2.12405
        • McDonagh TA
        • Metra M
        • Adamo M
        • Gardner RS
        • Baumbach A
        • Böhm M
        • et al.
        2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.
        Eur Heart J. 2021; 42: 3599-3726https://doi.org/10.1093/eurheartj/ehab368
        • Kamiya K
        • Yamamoto T
        • Tsuchihashi-Makaya M
        • Ikegame T
        • Takahashi T
        • Sato Y
        • et al.
        Nationwide survey of multidisciplinary care and cardiac rehabilitation for patients with heart failure in Japan: an analysis of the AMED-CHF study.
        Circ J. 2019; 83: 1546-1552https://doi.org/10.1253/circj.CJ-19-0241
        • Kikuchi A
        • Taniguchi T
        • Nakamoto K
        • Sera F
        • Ohtani T
        • Yamada T
        • et al.
        Feasibility of home-based cardiac rehabilitation using an integrated telerehabilitation platform in elderly patients with heart failure: a pilot study.
        J Cardiol. 2021; 78: 66-71https://doi.org/10.1016/j.jjcc.2021.01.010
        • Packer DL
        • Piccini JP
        • Monahan KH
        • HR Al-Khalidi
        • Silverstein AP
        • Noseworthy PA
        • et al.
        Ablation versus drug therapy for atrial fibrillation in heart failure.
        Circulation. 2021; 143: 1377-1390https://doi.org/10.1161/CIRCULATIONAHA.120.050991
        • Machino-Ohtsuka T
        • Seo Y
        • Ishizu T
        • Yamamoto M
        • Hamada-Harimura Y
        • Machino T
        • et al.
        Relationships between maintenance of sinus rhythm and clinical outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation.
        J Cardiol. 2019; 74: 235-244https://doi.org/10.1016/j.jjcc.2019.02.014
        • Fukui A
        • Tanino T
        • Yamaguchi T
        • Hirota K
        • Saito S
        • Okada N
        • et al.
        Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction.
        J Cardiovasc Electrophysiol. 2020; 31: 682-688https://doi.org/10.1111/jce.14369
        • Machino-Ohtsuka T
        • Seo Y
        • Ishizu T
        • Sugano A
        • Atsumi A
        • Yamamoto M
        • et al.
        Efficacy, safety, and outcomes of catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction.
        J Am Coll Cardiol. 2013; 62: 1857-1865https://doi.org/10.1016/j.jacc.2013.07.020
        • Nagai T
        • Yoshikawa T
        • Saito Y
        • Takeishi Y
        • Yamamoto K
        • Ogawa H
        • et al.
        Clinical characteristics, management, and outcomes of japanese patients hospitalized for heart failure with preserved ejection fraction: a report from the Japanese Heart Failure Syndrome With Preserved Ejection Fraction (JASPER) registry.
        Circ J. 2018; 82: 1534-1545https://doi.org/10.1253/circj.CJ-18-0073
        • Sotomi Y
        • Iwakura K
        • Hikoso S
        • Inoue K
        • Onishi T
        • Okada M
        • et al.
        Prognostic significance of the HFA-PEFF score in patients with heart failure with preserved ejection fraction.
        ESC Heart Fail. 2021; 8: 2154-2164https://doi.org/10.1002/ehf2.13302
        • Harada T
        • Yamaguchi M
        • Omote K
        • Iwano H
        • Mizuguchi Y
        • Amanai S
        • et al.
        Cardiac power output is independently and incrementally associated with adverse outcomes in heart failure with preserved ejection fraction.
        Circ Cardiovasc Imaging. 2022; 15e013495https://doi.org/10.1161/CIRCIMAGING.121.013495
        • Streng KW
        • Nauta JF
        • Hillege HL
        • Anker SD
        • Cleland JG
        • Dickstein K
        • et al.
        Non-cardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction.
        Int J Cardiol. 2018; 271: 132-139https://doi.org/10.1016/j.ijcard.2018.04.001
        • Meyer M
        • Du Fay Lavallaz J
        • Benson L
        • Savarese G
        • Dahlström U
        • Lund LH
        Association between β-blockers and outcomes in heart failure with preserved ejection fraction: current insights from the SwedeHF registry.
        J Card Fail. 2021; 27: 1165-1174https://doi.org/10.1016/j.cardfail.2021.04.015
        • Kapłon-Cieślicka A
        • Benson L
        • Chioncel O
        • Crespo-Leiro MG
        • Coats AJS
        • Anker SD
        • et al.
        A comprehensive characterization of acute heart failure with preserved versus mildly reduced versus reduced ejection fraction: insights from the ESC-HFA EORP Heart Failure Long-Term Registry.
        Eur J Heart Fail. 2022; 24: 335-350https://doi.org/10.1002/ejhf.2408
        • Uijl A
        • Veenis JF
        • Brunner-La Rocca HP
        • van Empel V
        • Linssen GCM
        • Asselbergs FW
        • et al.
        Clinical profile and contemporary management of patients with heart failure with preserved ejection fraction: results from the CHECK-HF registry.
        Neth Heart J. 2021; 29: 370-376https://doi.org/10.1007/s12471-020-01534-7
        • Garg P
        • Dakshi A
        • Assadi H
        • Swift AJ
        • Naveed U
        • Fent G
        • et al.
        Characterisation of the patients with suspected heart failure: experience from the SHEAF registry.
        Open Heart. 2021; 8e001448https://doi.org/10.1136/openhrt-2020-001448
        • Ziaeian B
        • Hernandez AF
        • DeVore AD
        • Wu J
        • Xu H
        • Heidenreich PA
        • et al.
        Long-term outcomes for heart failure patients with and without diabetes: from the Get With The Guidelines Heart Failure Registry.
        Am Heart J. 2019; 211: 1-10https://doi.org/10.1016/j.ahj.2019.01.006
        • Mohammed SF
        • Borlaug BA
        • Roger VL
        • Mirzoyev SA
        • Rodeheffer RJ
        • Chirinos JA
        • et al.
        Comorbidity and ventricular and vascular structure and function in heart failure with preserved ejection fraction a community-based study.
        Circ Heart Fail. 2012; 5: 710-719https://doi.org/10.1161/CIRCHEARTFAILURE.112.968594
        • Sato Y
        • Yoshihisa A
        • Oikawa M
        • Nagai T
        • Yoshikawa T
        • Saito Y
        • et al.
        Relation of systolic blood pressure on the following day with post-discharge mortality in hospitalized heart failure patients with preserved ejection fraction.
        Int Heart J. 2019; 60: 876-885https://doi.org/10.1536/ihj.18-699