Deliberating the Diagnostic Dilemma of Heart Failure With Preserved Ejection Fraction.
Deliberating the Diagnostic Dilemma of Heart Failure With Preserved Ejection Fraction.
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DOI：
10.1161/circulationaha.119.041818
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发表时间：
2020-11-03
期刊：
影响因子：
37.8
通讯作者：
Lam CSP
中科院分区：
文献类型：
--
作者：
Ho JE;Redfield MM;Lewis GD;Paulus WJ;Lam CSP
关于射血分数保留性心力衰竭（HFpEF）的定义缺乏共识，各学会指南的诊断标准差异很大。疾病定义缺乏统一性，部分原因是对疾病病理生物学、表型异质性和自然史的不完全理解。我们回顾目前的知识差距和现有的诊断工具和算法。我们提出了一个简单的方法来实现这些工具的限制，目前的知识基础，分别解决（1）住院个人休息充血，诊断更简单，（2）个人运动不耐受，诊断更复杂。在这里，先进的或挑衅性的测试，包括运动的血流动力学反应的评价被认为是一个潜在的作用。更重要的是，我们提出了未来研究的重点领域，以开发准确可行的HFpEF诊断工具，包括重现人类HFpEF的动物模型，以及既解决HFpEF病理生物学的基本理解，又解决新的诊断方法和工具的人类研究。总之，迫切需要更准确地定义HFpEF综合征，以便为诊断、临床试验的患者选择以及最终的未来治疗方法提供信息。
There is a lack of consensus on how we define heart failure with preserved ejection fraction (HFpEF), with wide variation in diagnostic criteria across society guidelines. This lack of uniformity in disease definition stems in part from an incomplete understanding of disease pathobiology, phenotypic heterogeneity, and natural history. We review current knowledge gaps and existing diagnostic tools and algorithms. We present a simple approach to implement these tools within the constraints of the current knowledge base, addressing separately (1) hospitalized individuals with rest congestion, where diagnosis is more straightforward, and (2) individuals with exercise intolerance, where diagnosis is more complex. Here, a potential role for advanced or provocative testing, including evaluation of hemodynamic responses to exercise is considered. More importantly, we propose focus areas for future studies to develop accurate and feasible diagnostic tools for HFpEF, including animal models that recapitulate human HFpEF, and human studies that both address fundamental understanding of HFpEF pathobiology as well as new diagnostic approaches and tools. In sum, there is an urgent need to more accurately define the syndrome of HFpEF, in order to inform diagnosis, patient selection for clinical trials, and ultimately future therapeutic approaches.