{"id":"b27b2d6120b5","type":"article","url":"https://hartvaat.nl/2026/10/07/fenotype-gestuurde-apparatuur-en-kathetergerichte-therapieen-bij-hfpef/","title":"Fenotype-gestuurde apparatuur en kathetergerichte therapieën bij HFpEF","title_en":"Novel device-based and catheter-directed therapies for heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Cardiovascular intervention and therapeutics","doi":"10.1007/s12928-026-01353-4","source_url":"https://doi.org/10.1007/s12928-026-01353-4","authors":["Eiichiro Yamamoto","Yasuhiro Izumiya","Kenichi Tsujita"],"significance":5,"published":"2026-10-15","source_date":"2026-10-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This narrative review outlines the evolving management of heart failure with preserved ejection fraction (HFpEF), highlighting a shift from empirical treatment to phenotype-guided, personalised strategies. Precise patient selection is emphasised as critical for device efficacy, with interatrial shunts showing benefit primarily in those without elevated exercise pulmonary vascular resistance. Emerging modalities such as transcutaneous vagal nerve stimulation, cardiac contractility modulation, and splanchnic nerve ablation target underlying mechanisms like inflammation and calcium handling. Integrating these interventions with foundational pharmacotherapy (SGLT2 inhibitors, GLP-1 receptor agonists) and continuous haemodynamic monitoring may pave the way for closed-loop, individualised care.","created":"2026-10-08T01:17:58Z","updated":"2026-10-08T01:17:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze narratieve review beschrijft de verschuiving in de behandeling van hartfalen met een behouden ejectiefractie (HFpEF) van empirische strategieën naar fenotype-gestuurde, gepersonaliseerde aanpakken. Uit klinische inzichten blijkt dat precieze patiëntselectie cruciaal is; interatriale shunts tonen bijvoorbeeld vooral klinisch voordeel bij patiënten zonder verhoogde pulmonale vaatweerstand tijdens inspanning, terwijl nieuwe modaliteiten zoals vaguszenuwstimulatie, cardiac contractility modulation en splanchnicusablatie directe pathofysiologische mechanismen benaderen. De zorgparadigma verschuift naar synergistische multimodale benaderingen die bewezen farmacotherapie (SGLT2-remmers, GLP-1-RA) combineren met continue hemodynamische monitoring en gerichte interventies. Voor cardiologen en internisten biedt dit overzicht een actueel kader voor het evalueren van emerging therapies en het optimaliseren van precisiegeneeskunde bij HFpEF.","abstract_original":"Heart failure with preserved ejection fraction (HFpEF) presents a major clinical and therapeutic challenge owing to its complex pathophysiology and pronounced clinical heterogeneity. While traditional empirical strategies targeting comorbidities offered limited success, recent advances in molecular, hemodynamic, and autonomic profiling have catalyzed a fundamental shift toward phenotype-guided, personalized management. Clinical trial insights underscore that precise patient selection is paramount for therapeutic efficacy; for example, interatrial shunt interventions demonstrate clinical benefits primarily in patients without elevated exercise pulmonary vascular resistance, whereas improper application risks right ventricular decompensation. Simultaneously, novel device-based modalities, including transcutaneous vagal nerve stimulation, cardiac contractility modulation, splanchnic nerve ablation, and adjustable interatrial shunts, are emerging as promising avenues to directly address underlying mechanisms such as systemic inflammation, impaired calcium handling, and volume redistribution. Moving forward, the management paradigm of HFpEF will increasingly shift from monotherapy to synergistic multimodal approaches. Combining established foundational pharmacotherapies, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, with continuous pulmonary artery pressure monitoring and targeted interventional devices holds immense potential to establish closed-loop, individualized treatment strategies. In this review, we synthesize current clinical evidence, highlight key anatomical and hemodynamic considerations, evaluate emerging device platforms, and discuss future strategic perspectives aimed at optimizing precision medicine for patients with HFpEF."}