Reduced cardiac contractility is central to heart failure with reduced ejection fraction (HFrEF) manifestation and progression

References

  1. Kemp CD, et al. Cardiovasc Pathol. 2012;21:365-371.
  2. Piano MR, et al. Heart Lung. 1998;27:3-19.
  3. Hasenfuss G, et al. Pathophysiology of heart failure. Zipes DP, et al, eds. In: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Inc; 2019;442-461.
  4. Opie L, et al. Mechanisms of cardiac contraction and relaxation. In: Mann DL, et al, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Inc. 2012.
  5. Kuo IY, et al. Cold Spring Harb Perspect Biol. 2015;7:a006023. doi:10.1101/cshperspect.a006023
  6. Neubauer S. N Engl J Med. 2007;356:1140-1151.
  7. Wijayasiri L, et al. Cardiac contractility. In: Vincent JL, Hall JB, eds. Encyclopedia of Intensive Care Medicine. Berlin, Germany: Springer-Verlag Berlin Heidelberg. 2012;460-462.
  8. Psotka MA, et al. J Am Coll Cardiol. 2019;73:2345-2353.
  9. Solaro RJ. Pressure volume loops provide a quantification of contractility. In: Regulation of Cardiac Contractility. San Rafael, CA: Morgan & Claypool Life Sciences; 2011.
  10. Chengode S. Ann Card Anaesth. 2016;19(suppl):S26-S34.
  11. Biering-Sørensen T, et al. Eur J Heart Fail. 2018;20:1106-1114.
  12. Kolev N, et al. Anesth Analg. 1995;81:889-890.
  13. Solomon SD, et al. Circulation. 2005;112:3738-3744.
  14. Kolias TJ, et al. J Am Coll Cardiol. 2000;36:1594-1599.
  15. Cikes M, et al. Eur Heart J. 2016;37:1642-1650.
  16. Sheth PJ, et al. Radiographics. 2015;35:1335-1351.
  17. Meric M, et al. Int J Cardiovasc Imaging. 2014;30:1057-1064.
  18. Reant P, et al. Eur J Echocardiogr. 2010;11:834-844.
  19. Haiden A, et al. Am J Hypertens. 2014;27:702-709.
  20. Katz AM, et al. Euro Heart J. 2016;37:449-454.
  21. Mann DL, et al. Heart failure and cor pulmonale. In: Longo DL, et al, eds. Harrison’s Internal Medicine. 18th ed. New York, NY: McGraw Hill; 2012:1901-1915.
  22. Arrigo M, et al. Eur Heart J Suppl. 2016;18(suppl G):G11-G18.
  23. Klabunde RE, et al. Cellular structure and function. In: Klabunde RE, et al, ed. Cardiovascular Physiology Concepts. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins/Wolters Kluwer; 2012;41-59.
  24. MacLeod KT. F1000Research. 2016;5:1770. doi:10.12688/f1000research.8661.1. eCollection 2016.
  25. Bers DM, et al. Mechanisms of cardiac contraction and relaxation. In: Zipes DP, et al, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Inc. 2019:418-441.
  26. deGoma EM, et al. J Am Coll Cardiol. 2006;48:2397-2409.
  27. Kass DA, et al. Circulation. 2006;113:305-315.
  28. Martínez MS, et al. Vessel Plus. 2017;1:230-241.
  29. Wang J, et al. J Zhejiang Univ Sci B (Biomed & Biotechnol). 2013;14:688-695.
  30. Teerlink JR. Heart Fail Rev. 2009;14:289-298.
  31. Yancy CW, et al; Writing Committee Members. Circulation. 2013;128:e240-e327.
  32. Spudich JA. Biophys J. 2014;106:1236-1249.
  33. Planelles-Herrero VJ, et al. Nat Commun. 2017;8:190. doi:10.1038/s41467-017-00176-5
  34. Moss RL, et al. Circ Res. 2004;94:1290-1300.
  35. Zhou B, et al. J Clin Invest. 2018;128:3716-3726.
  36. Houser SR, et al. Circ Res. 2003;92:350-358.
  37. Luo M, et al. Circ Res. 2013;113:690-708.
  38. Jozwiak M, et al. Semin Respir Crit Care Med. 2011;32:206-214.
  39. Malik FI, et al. J Mol Cell Cardiol. 2011;51:454-461.
  40. Francis GS, et al. J Am Coll Cardiol. 2014;63:2069-2078.
  41. Ferrari R, et al. Euro Heart J Suppl. 2016 (suppl G);G3-G10.
  42. Atherton JJ. Scientifica (Cairo). 2012;2012:279731. doi:10.6064/2012/279731
  43. Kato T, et al. World J Cardiol. 2014;6:1175-1191.
  44. Choi HM, et al. Korean J Intern Med. 2019;34:11-43.

There are multiple pathophysiologic processes associated with HFrEF. One such process involves impaired contractility, which is the primary myocardial defect in the pathophysiology of HFrEF.1-3

Following an index event, there is progessive decline in left ventricular (LV) contractile function.3

Cellular-level progression of HFrEF involves multiple changes to cardiomyocyte structure and function, all of which impact cardiac contractility.2

Inotropy is the contractile ability of the cardiac muscle to generate a force of contraction independent of any load or stretch applied.1,7 Contractility manifests as myocardial fiber shortening, which increases ventricular pressure.5,8

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