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Johns Hopkins' Center for Heart Failure with Preserved Ejection Fraction

Older Woman with Heart Condition

A Proud Member of the American Heart Association's Go Red for Women Research Network
 

Our Center
Our Mission
Our Experts
What is Heart Failure with Preserved Ejection Fraction?
Our Research
 

Johns Hopkins’ investigators, have been awarded a grant to create one of five centers that form the American Heart Association's (AHA) Go Red for Women Research Network. The award supports our Center for Heart Failure with Preserved Ejection Fraction (HFpEF) over a four-year period, and will support work spanning from basic science to population/epidemiology studies.

Learn more about the AHA’s Go Red for Women Research Network.

Our Center

The Johns Hopkins’ Center for Heart Failure with Preserved Ejection Fraction (HFpEF) was founded in 2014 by Dr. Kavita Sharma with the aim to provide specialized care for patients with this form of heart failure through education, research and a comprehensive approach to heart failure management.

Our Mission

  • To provide excellent clinical care for people with heart failure with preserved ejection fraction.
  • To educate health care practitioners and trainees to better identify and treat patients with this form of heart failure.
  • To lead clinical and translational research to study heart failure with preserved ejection fraction, from mechanisms of disease to therapeutic targets.

What is Heart Failure with Preserved Ejection Fraction?

Heart failure with preserved ejection fraction (HFpEF) is a common, debilitating syndrome which accounts for nearly half of the 6.6 million cases of heart failure in the U.S. yearly and is known to cause nearly 50 % of all hospitalizations for heart failure (HF) in the U.S.  It is associated with a high mortality rate of over 50 % at 5 years after hospitalization.

Ejection fraction is a measurement that determines how well your heart pumps blood. It is usually expressed as a percentage and is used to properly diagnose and treat heart failure.

In HFpEF, the main pumping chamber of the heart (left ventricle) is able to contract/pump relatively normally (normal ejection fraction); however, it is unable to relax normally between each heartbeat. This can result in the development of higher pressure within the left ventricle as the blood fills the left ventricle between each beat. 

Symptoms of HFpEF include the following:

  • shortness of breath
  • lower leg swelling
  • abdominal swelling
  • exercise intolerance
  • fatigue

HFpEF has become more prevalent as people age and is associated with risk factors such as hypertension, obesity, kidney disease, diabetes and atrial fibrillation.

Currently, research is ongoing for successful therapies in HFpEF and there are a handful of clinics, including the Johns Hopkins Center for HFpEF, that are dedicated to the diagnosis and treatment of HFpEF.

Our Research

There are a number of clinical and translational research projects ongoing in the Johns Hopkins HFpEF Center that range from studies to investigate mechanisms of disease, to multi-center treatment trials for HFpEF. 

Ongoing Clinical Studies:

  • AHA Go Red For Women Network Grant Studies:
    • Heart Failure with Preserved EF: Female sex-hormones and cyclic GMP-PKG Modulation of Cardiac Disease and metabolism
  • Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction (PARAGON-HF), NCT01920711
  • In Vivo Cardiac and Skeletal Muscle Metabolism in Heart Failure with Preserved Ejection Fraction Patients During Rest and Plantar Flexion Exercise
  • Inorganic Nitrite Delivery to Improve Exercise Capacity in HFpEF (INDIE-HFpEF), NCT02742129

Completed Clinical Studies

About AHA Go Red for Women

The Johns Hopkins HFpEF Center is proud to been one of 5 named AHA Go Red for Women Networks. The objective of the network is to understand the basis for sex differences in development and prevalence of HFpEF.  Some of these differences include:

  • Sixty percent of patients with HFpEF are women, typically post-menopausal women.
  • Women with HFpEF have differences in cardiac structure/function and certain biochemical markers compared to men.
  • Animal models suggest that sex differences in biochemical pathways in heart muscle (cyclic guanosine monophosphate - protein kinase G (cGMP-PKG) signaling) may be critical.
  • Loss of estrogen at menopause can affect some of these pathways which may have broad adverse effects in the heart, fat tissue, and skeletal muscle.

The AHA Go Red for Women Network aims to better understand and develop personalized approaches for the prevention and management of HFpEF in the following ways:

  • Test if the sex bias in HFpEF results from post-menopausal changes by studying the effects of sex hormones on biochemical pathways (cGMP-PKG) that are involved in HFpEF.
  • Train a new generation of researchers in translational approaches that consider sex difference in the study of disease states.
  • Participate in the national AHA Go Red for Women’s Research Network activities to foster collaboration among researchers from the member institutions.

Basic Science Project

The Basic Science Project aims to improve targeting of cGMP- PKG HFpEF therapy to circumvent estrogen deficiency.

  • Significance: By focusing on sex-hormone dependent biology, we hope to identify novel treatments for HFpEF and improve the possibility to better match therapy for HFpEF to individual patient characteristics
  • Innovation: We are exploring novel biochemical pathways that are involved in heart muscle in HFpEF
  • Impact: Our goal is to develop female hormone-independent strategies to better personalize treatment of post-menopausal women

Clinical Science Project

The Clinical Science Project focuses on developing a deeper understanding of the way the heart, blood vessels and skeletal muscle function in patients with HFpEF, and to conduct small clinical trials to dissect the role of sex hormones and their influence on the biochemical pathways involving cGMP-PKG in patients with HFpEF. These studies will be conducted at Johns Hopkins Hospital, Hopkins Bayview Medical Center and at Northwestern University Hospital.

  • Significance: Studies could lead to novel therapeutic approaches for HFpEF in women that leverage our knowledge of these biochemical pathways
  • Innovation: We are conducting novel assessment of heart and skeletal muscle in HFpEF. The clinical studies will explore the effects of new therapies targeted at these biochemical pathways
  • Impact: This study looks at whether developing a greater understanding of the biology of sex differences may allow improved understanding of the pathology of HFpEF and provide novel insights into treatments in cardiovascular disease

Population Science Project

The Population Science Project will use data obtained in three large studies of individuals who were initially without heart disease and who have been followed for decades. This research will study the role of sex hormones, oxidative stress, and cGMP in the development of HFpEF over the long term follow up of these populations. 

  • Significance: This will study sex differences and mechanisms leading to subclinical HFpEF in a broad population who have been followed over the span of the adult life course including menopausal transition
  • Innovation: The biochemical pathways of interest (cGMP) have not previously studied in population cohorts, nor have they been studied as a sex hormone-related pathway to HFpEF
  • Impact: The studies are a first step in identifying potential interventions and treatment targets that we hope may lead to more personalized approaches to treating individuals with HFpEF

Our Experts

About Our HFpEF Center Director 

Dr. Kavita SharmaDr. Kavita Sharma completed her Osler Internal Medicine Residency training, Cardiology fellowship training and Advanced Heart Failure/Transplant Cardiology fellowship training in 2015 at Johns Hopkins.  She founded the JHH HFpEF Center in 2014, with the goal to provide patients with HFpEF specialized heart failure care with multi-disciplinary approach to care, in addition to developing a clinical and translational research program in HFpEF.  Her specific clinical and research interests include better defining clinical phenotypes of HFpEF, understanding underlying pathophysiology of this disease at the molecular level from tissue, and the evaluation of clinical therapies. She is a co-Principal Investigator (PI) of the recently awarded AHA Go Red for Women Network grant, and is the PI of a number of HFpEF-centered clinical and translational studies that are ongoing at Johns Hopkins.

 

AHA Go Red for Women Center Director

Photo of Dr. Pamela Ouyang, M.B.B.S., M.D.

Ouyang, Pamela, M.B.B.S., M.D.

Professor of Medicine
Director, Johns Hopkins Women's Cardiovascular Health Center
 

Basic Science Principal Investigator

Photo of Dr. David Alan Kass, M.D.

Kass, David Alan, M.D.

Professor of Medicine
Professor of Biomedical Engineering
Professor of Pharmacology and Molecular Sciences
Abraham and Virginia Weiss Professor of Cardiology
 

 Clinical Science Principal Investigators

 

Dr. Sanjiv Shah

Sanjiv Shah, M.D.

Professor of Medicine
Primary Location: Northwestern University Feinberg of Medicine, Chicago, Illinois

Director of the Heart Failure with Preserved Ejection Fraction Prgoram
Northwestern Memorial Hospital, Chicago, Illinois

 
Photo of Dr. Kavita Sharma, M.D.

Sharma, Kavita, M.D.

Assistant Professor of Medicine
Director, Johns Hopkins Heart Failure with Preserved Ejection Fraction Program
Primary Location: Johns Hopkins Outpatient Center
 

Population Science Principal Investigators

Photo of Dr. Wendy Susan Post, M.D., M.S.

Post, Wendy Susan, M.D., M.S.

Professor of Medicine
Director of Cardiovascular Research, Division of Cardiology
Johns Hopkins Cardiovascular Fellowship Research Director
 
Photo of Dr. Dhananjay Madhukar Vaidya, M.B.B.S., M.P.H., Ph.D.
 

Training Program Director

Photo of Dr. Erin Donnelly Michos, M.D., M.H.S.

Michos, Erin Donnelly, M.D., M.H.S.

Associate Professor of Medicine
Director of Women's Cardiovascular Health
Associate Director of Preventive Cardiology, the Ciccarone Center for the Prevention of Cardiovascular Disease