Heart Failure With Mid-Range (Borderline) Ejection Fraction: Clinical Implications and Future Directions.
Heart Failure With Mid-Range (Borderline) Ejection Fraction: Clinical Implications and Future Directions.
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DOI：
10.1016/j.jchf.2017.06.013
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Fonarow GC
中科院分区：
文献类型：
--
作者：
Hsu JJ;Ziaeian B;Fonarow GC
具有临界射血分数的心力衰竭(HF)于2013年在美国心脏病学会/美国心脏协会指南中首次被定义为存在典型的HF症状和左心室射血分数(LVEF)在41%至49%之间。2016年，欧洲心脏病学会将中段射血分数(HFmrEF)的HF指定为LVEF在40%至49%之间。与射血分数保留的心衰(HFpEF)和射血分数降低的心衰(HFrEF)相比，对LVEF的这一范围的研究较少。尽管有有效的、指南指导的药物治疗HFrEF患者，但到目前为止还没有任何治疗方法显示出对HFpEF的可衡量的益处。HFmrEF患者的临床特征和预后更接近于HFpEF患者，与HFrEF患者相比，有一定的区别。这些患者是否代表了一个独特的、动态的HF群体，是否可以从已知对HFrEF患者有益的靶向治疗中受益，如神经激素阻断，还需要进一步研究。本文综述了HFmrEF患者的临床流行病学、病理生理学和预后的已知情况，并将这些特征与研究更充分的HF组进行了比较。尽管目前推荐的治疗方法主要集中在合并症的积极治疗上，但我们总结了确定有益治疗的潜在信号的研究。未来的研究不仅需要更好地描述HFmrEF人群的特征，而且还需要确定有效的管理策略，以减少这一表型心力衰竭患者的高心血管发病率和死亡负担。
Heart failure (HF) with borderline ejection fraction was first defined in 2013 in the American College of Cardiology/ American Heart Association guidelines as the presence of the typical symptoms of HF and a left ventricular ejection fraction (LVEF) of 41% to 49%. In 2016, the European Society of Cardiology specified HF with mid-range ejection fraction (HFmrEF) as LVEF of 40% to 49%. This range of LVEF is less well studied compared with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). Although there are effective, guideline-directed medical therapies for patients with HFrEF, no therapies thus far show measurable benefit in HFpEF. Patients with HFmrEF have a clinical profile and prognosis that are closer to those of patients with HFpEF than those of HFrEF, with certain distinctions. Whether these patients represent a unique and dynamic HF group that may benefit from targeted therapies known to be beneficial in patients with HFrEF, such as neurohormonal blockade, requires further study. This review summarizes what is known about the clinical epidemiology, pathophysiology, and prognosis for patients with HFmrEF and how these features compare with the more well-studied HF groups. Although recommended treatments currently focus on aggressive management of comorbidities, we summarize the studies that identify a potential signal for beneficial therapies. Future studies are needed to not only better characterize the HFmrEF population but to also determine effective management strategies to reduce the high cardiovascular morbidity and mortality burden on this phenotype of patients with HF.
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影响因子：
2.8
作者：
Sweitzer, Nancy K.;Lopatin, Margarita;Stevenson, Lynne W.
通讯作者：
Stevenson, Lynne W.
DOI：
10.1161/circheartfailure.111.966366
发表时间：
2012-11
期刊：
Circulation. Heart failure
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--
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作者：
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作者：
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