What is systolic heart failure?

From the Guidelines

Systolic heart failure is a condition characterized by a left ventricular ejection fraction (LVEF) of 40% or less, where the heart's left ventricle cannot contract with enough force to pump sufficient blood to meet the body's needs. This type of heart failure occurs when the heart muscle weakens and loses its ability to squeeze properly during heartbeats, often due to conditions such as coronary artery disease, heart attacks, high blood pressure, and certain viral infections 1. The clinical syndrome of heart failure may result from disorders of the pericardium, myocardium, endocardium, or heart valves, but most patients have symptoms related to impaired LV myocardial function.

Key Characteristics

• Reduced ejection fraction (typically less than 40%)
• Weakened heart muscle
• Inability of the heart to squeeze properly during heartbeats
• Common causes include coronary artery disease, heart attacks, high blood pressure, and certain viral infections
• Symptoms include shortness of breath, fatigue, swelling in the legs and ankles, and reduced exercise tolerance

Diagnosis and Classification

According to the acc/aha guidelines, HFrEF is defined by clinical HF syndrome with LVEF ≤40%, whereas HFpEF encompasses HF patients with LVEF ≥50% 1. The ESC criteria require additional supportive findings beyond signs or symptoms of HF, including elevated levels of natriuretic peptide, and objective evidence of structural or functional alterations.

Treatment and Management

Treatment for systolic heart failure typically involves medications such as ACE inhibitors, beta-blockers, diuretics, and aldosterone antagonists, as well as lifestyle modifications including sodium restriction, fluid limitation, regular physical activity, and avoiding alcohol and tobacco. For severe cases, devices like implantable cardioverter-defibrillators or cardiac resynchronization therapy may be recommended 1. The goal of treatment is to reduce the workload on the heart, improve cardiac function, and prevent further heart muscle damage by addressing the neurohormonal imbalances that occur when the heart struggles to maintain adequate circulation.

From the FDA Drug Label

Lisinopril tablets USP are indicated to reduce signs and symptoms of systolic heart failure In two placebo controlled, 12-week clinical studies compared the addition of lisinopril up to 20 mg daily to digitalis and diuretics alone. The combination of lisinopril, digitalis and diuretics reduced the following signs and symptoms of heart failure: edema, rales, paroxysmal nocturnal dyspnea and jugular venous distention A large (over 3,000 patients) survival study, the ATLAS Trial, comparing 2. 5 mg and 35 mg of lisinopril in patients with systolic heart failure, showed that the higher dose of lisinopril had outcomes at least as favorable as the lower dose Systolic heart failure is a condition where the heart is unable to pump blood efficiently, leading to increased pressure and fluid buildup in the lungs and other parts of the body.

• The signs and symptoms of systolic heart failure include:

• Edema
• Rales
• Paroxysmal nocturnal dyspnea
• Jugular venous distention

• Treatment with lisinopril has been shown to reduce these signs and symptoms, as well as improve exercise tolerance and reduce mortality in patients with systolic heart failure 2 2.

From the Research

Definition and Causes of Systolic Heart Failure

• Systolic heart failure is a condition where the heart is unable to pump blood efficiently, leading to a decrease in cardiac output 3.
• The two main causes of heart failure are coronary artery disease (CAD) and hypertension, with CAD being a major cause of systolic heart failure and hypertension being a major cause of diastolic heart failure, especially in the elderly 3.
• The lifetime risk of developing heart failure is approximately 20%, increasing to 40% if hypertension is present 3.

Treatment of Systolic Heart Failure

• Beta-blockers have become a cornerstone in the treatment of systolic heart failure, alongside ACE inhibitors, and have been shown to reduce all-cause death by 34-5% 3.
• The combination of beta-blockers and ACE inhibitors has been found to be effective in reducing mortality and morbidity in patients with systolic heart failure 4, 5, 6.
• Other treatments for systolic heart failure include aldosterone antagonists, angiotensin receptor blockers, diuretics, and vasodilators, which have been shown to improve outcomes in patients with heart failure 4, 5, 6.

Management of Systolic Heart Failure in the Elderly

• The treatment of systolic heart failure in the elderly is similar to that in younger patients, with beta-blockers, ACE inhibitors, and other therapies being effective in reducing mortality and morbidity 5.
• However, the elderly may be more susceptible to adverse effects from these medications, and close monitoring is necessary to minimize risks 5.
• The choice of beta-blocker is important, as benefit is not a class-effect, and certain beta-blockers such as bisoprolol, metoprolol, and carvedilol have been shown to be more effective than others 3, 6.