Similarities and Differences Between HFmrEF and HFpEF.
Similarities and Differences Between HFmrEF and HFpEF.
复制标题
HFmrEF 和 HFpEF 之间的异同
DOI：
10.3389/fcvm.2021.678614
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发表时间：
2021
影响因子：
3.6
通讯作者：
Zeng Q
中科院分区：
文献类型：
--
作者：
Li P;Zhao H;Zhang J;Ning Y;Tu Y;Xu D;Zeng Q
新指南根据射血分数（EF）将心力衰竭（HF）分为三个亚组：射血分数降低的心力衰竭（HFrEF）、中等射血分数的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）。关于将 HFmrEF 宣布为独特表型的新指南实现了促进对左心室 EF 为 40-49% 的 HF 患者的基本特征、病理生理学和治疗的研究的目标。 HFmrEF 患者通常被描述为 HFrEF 和 HFpEF 患者之间的中间人群；然而，就病因和临床指标而言，他们与HFrEF人群更为相似。就临床预后而言，它们更接近 HFpEF，因为这两个人群都有良好的预后和生活质量。同时，越来越多的证据表明，HFmrEF和HFpEF在表现和病理生理学上表现出异质性，而这种异质性的出现往往在疾病的预后和治疗中发挥着至关重要的作用。迄今为止，对 HFmrEF 和 HFpEF 的确切机制和有效治疗策略仍知之甚少，但来自观察性研究和随机对照试验事后分析的当前一些证据表明，HFmrEF 患者可能从 HFrEF 治疗策略中获益更多，如 β 受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、盐皮质激素受体拮抗剂和沙库巴曲/缬沙坦。本综述总结了当前临床实践和机制研究的流行病学、病因、临床指标、机制和治疗方面的可用数据，以讨论 HFmrEF 和 HFpEF 患者之间的潜在关联。
The new guidelines classify heart failure (HF) into three subgroups based on the ejection fraction (EF): HF with reduced EF (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF). The new guidelines regarding the declaration of HFmrEF as a unique phenotype have achieved the goal of stimulating research on the basic characteristics, pathophysiology, and treatment of HF patients with a left ventricular EF of 40–49%. Patients with HFmrEF have more often been described as an intermediate population between HFrEF and HFpEF patients; however, with regard to etiology and clinical indicators, they are more similar to the HFrEF population. Concerning clinical prognosis, they are closer to HFpEF because both populations have a good prognosis and quality of life. Meanwhile, growing evidence indicates that HFmrEF and HFpEF show heterogeneity in presentation and pathophysiology, and the emergence of this heterogeneity often plays a crucial role in the prognosis and treatment of the disease. To date, the exact mechanisms and effective treatment strategies of HFmrEF and HFpEF are still poorly understood, but some of the current evidence, from observational studies and post-hoc analyses of randomized controlled trials, have shown that patients with HFmrEF may benefit more from HFrEF treatment strategies, such as beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sacubitril/valsartan. This review summarizes available data from current clinical practice and mechanistic studies in terms of epidemiology, etiology, clinical indicators, mechanisms, and treatments to discuss the potential association between HFmrEF and HFpEF patients.