Phenotypic spectrum of heart failure with preserved ejection fraction.
Phenotypic spectrum of heart failure with preserved ejection fraction.
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DOI：
10.1016/j.hfc.2014.04.008
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发表时间：
2014-07
影响因子：
3.4
通讯作者：
Deo RC
中科院分区：
文献类型：
--
作者：
Shah SJ;Katz DH;Deo RC
心力衰竭伴保留射血分数（HFpEF）是一种异质性综合征，具有多种潜在的病因和病理生理因素。虽然先前的心力衰竭临床试验使用了“一刀切”的方法，但这种方法并未被证明对HFpEF是成功的。此外，随着人口老龄化和肥胖、糖尿病和高血压的流行，HFpEF的患病率将在可预见的未来继续增长。再加上HFpEF综合征的高发病率和高死亡率，亟待改善HFpEF患者的临床护理和设计更好的HFpEF临床试验。因此，改进HFpEF表型谱的分类对于推进HFpEF领域并开始为这些患者提供靶向治疗至关重要。在此，我们描述了HFpEF的4种可能的分类模式：(1)病理生理分类；(2)临床/病因分类；(3)根据临床表现的类型进行分类；(4) HFpEF的表型组学（“表型图谱”）。利用这些模式改进HFpEF的表型分类现在是可能的，因为有大量的工具可以对HFpEF患者进行“密集表型”。这种分类应该导致临床护理和临床试验，其中基于特定疾病机制的靶向治疗可以与最有可能对这些治疗产生反应的特定患者亚型相匹配。此外，创新的分析策略，如“现象映射”，可能允许使用密集的多维数据来创建新的表型特征，这将有助于识别对特定治疗特别敏感的HFpEF患者。
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome, with several underlying etiologic and pathophysiologic factors. While prior heart failure clinical trials have used a “one size fits all” approach, this approach has not proven successful for HFpEF. Furthermore, with the aging population and epidemics of obesity, diabetes, and hypertension, the prevalence of HFpEF will continue to grow over the foreseeable future. Coupled with the high morbidity and mortality of the HFpEF syndrome, there remains a pressing unmet need to improve the clinical care of HFpEF patients and to design better HFpEF clinical trials. Improved classification of the wide HFpEF phenotypic spectrum is therefore essential to advance the HFpEF field and begin to provide targeted treatment for these patients. Here we describe 4 potential classification schemas for HFpEF: (1) pathophysiologic classification; (2) clinical/etiologic classification; (3) classification based on type of clinical presentation; and (4) phenomics (“phenomapping”) of HFpEF. Improved phenotypic categorization of HFpEF using these schemas is now possible given the multitude of tools available to perform “dense phenotyping” of HFpEF patients. Such categorization should lead to clinical care and clinical trials where targeted therapies based on specific mechanisms of disease can be matched to the specific patient subtypes most likely to respond to those therapies. In addition, innovative analytic strategies, such as “phenomapping”, may allow for the use of dense multi-dimensional data to create novel phenotypic signatures, which should help identify HFpEF patients who are particularly responsive to specific treatments.
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影响因子：
24
作者：
Burgess, MI;Jenkins, C;Marwick, TH
通讯作者：
Marwick, TH
影响因子：
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作者：
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通讯作者：
Kass, DA
影响因子：
3.7
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Redfield, Margaret M.
DOI：
10.1016/j.amjcard.2012.05.014
发表时间：
2012-09-15
期刊：
The American journal of cardiology
影响因子：
--
作者：
Anjan VY;Loftus TM;Burke MA;Akhter N;Fonarow GC;Gheorghiade M;Shah SJ
通讯作者：
Shah SJ