Elucidating the Clinical Implications and Pathophysiology of Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction: A Call to Action: A Science Advisory From the American Heart Association.
Elucidating the Clinical Implications and Pathophysiology of Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction: A Call to Action: A Science Advisory From the American Heart Association.
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DOI：
10.1161/cir.0000000000001079
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发表时间：
2022-08-16
期刊：
影响因子：
37.8
通讯作者：
Maron, Bradley A.
中科院分区：
文献类型：
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作者：
Brittain, Evan L.;Thenappan, Thenappan;Huston, Jessica H.;Agrawal, Vineet;Lai, Yen-Chun;Dixon, Debra;Ryan, John J.;Lewis, Eldrin F.;Redfield, Margaret M.;Shah, Sanjiv J.;Maron, Bradley A.
本声明着重于需要更好地了解射血分数正常的心力衰竭患者肺动脉高压（PH）的流行病学、病理生理学和治疗。这种临床表型很重要，因为它很常见，与不良结局密切相关，并且缺乏循证治疗。我们的目标是澄清关于射血分数保留的HF所致PH的关键知识差距，并为解决此类差距提出具体的可操作的科学方向。需要进一步研究的领域包括完善的疾病定义和血流动力学解释，以及对PH风险的非心脏因素的更深入了解，优化的动物模型，以及对合并前和后毛细血管PH患者的进一步分子研究。我们强调了翻译方法，这些方法可能为病理生理学提供重要的生物学见解，并揭示新的治疗靶点。最后，我们讨论了射血分数保留和肺血管功能障碍心力衰竭患者的潜在治疗方法的当前和未来前景，包括精密医学，新型试验设计和基于器械的治疗等考虑因素。这份声明提供了一个重要的知识差距的综合，最终在一系列具体的研究重点，我们认为值得投资的科学界。
This statement focuses on the need to better understand the epidemiology, pathophysiology, and treatment of pulmonary hypertension (PH) in patients with heart failure with preserved ejection fraction. This clinical phenotype is important because it is common, strongly associated with adverse outcomes, and lacks evidence-based therapies. Our goal is to clarify key knowledge gaps around PH due to HF with preserved ejection fraction and to suggest specific, actionable scientific directions for addressing such gaps. Areas in need of additional investigation include refined disease definitions and interpretation of hemodynamics as well as greater insights on non-cardiac contributors to PH risk, optimized animal models, and further molecular studies in patients with combined pre- and post-capillary PH. We highlight translational approaches that may provide important biologic insight into pathophysiology and reveal new therapeutic targets. Finally, we discuss the current and future landscape of potential therapies for patients with heart failure with preserved ejection fraction and pulmonary vascular dysfunction including considerations of precision medicine, novel trial design, and device-based therapies among other considerations. This statement provides a synthesis of important knowledge gaps culminating in a collection of specific research priorities that we argue warrant investment from the scientific community.