Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction.
Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction.
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DOI：
10.1161/jaha.115.002477
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发表时间：
2016-01-25
影响因子：
5.4
通讯作者：
Le Jemtel TH
中科院分区：
文献类型：
--
作者：
Samson R;Jaiswal A;Ennezat PV;Cassidy M;Le Jemtel TH
在过去的20年里，射血分数保留的心力衰竭综合征受到了极大的关注。1-19然而，治疗进展甚微。20-27在可能解释适度治疗进展的问题中，一个似乎是压倒性的：HFpEF不是一个定义明确的临床实体：它是心血管、代谢、肾脏和老年疾病的混合体。目前诊断为HFpEF的29名患者中，28名直到几年前还因系统性高血压、冠状动脉疾病(CAD)、肥胖、肾功能损害、肺动脉高压(PH)或年龄相关的解除条件而接受治疗。改善HFpEF患者预后的合理方法可能是根据导致他们寻求医疗护理的情况对患者进行治疗。正如其他人所指出的，需要一种面向表型的方法来治疗心力衰竭(HF)，特别是HFpEF。29-31 HFpEF的诊断依赖于心衰的体征和症状，以及左心室射血分数(LV)正常。左室舒张功能不全(LVDD)并不能确定心衰的存在，而可能偏向于心脏在HFpEF发病机制中的排他性作用。32、33作为一个整体，对HFpEF进行了广泛的审查。1-19本综述重点介绍四种常见的HFpEF临床表型及其并存情况(图)。文中还讨论了治疗的意义。
Over the past 2 decades, the syndrome of heart failure with preserved ejection fraction (HFpEF) received a lot of attention. 1–19 However, little therapeutic progress was made. 20–27 Among the issues that may account for the modest therapeutic progress, one appears to be overwhelming: HFpEF is not a well-defined clinical entity: It is an amalgam of cardiovascular, metabolic, renal, and geriatric conditions. 28, 29 Patients diagnosed with HFpEF currently, were until few years ago managed for systemic hypertension, coronary artery disease (CAD), obesity, renal impairment, pulmonary hypertension (PH), or age-related deconditioning. A rational approach for improving the outcome of patients with HFpEF may be to treat patients according to the conditions that led them to seek medical attention. As noted by others, a phenotype-oriented approach to heart failure (HF) and, in particular, to HFpEF is needed. 29–31 The diagnosis of HFpEF rests on the presence of signs and symptoms of HF and a normal left ventricular (LV) ejection fraction. Left ventricular diastolic dysfunction (LVDD) does not establish the presence of HF and may bias toward an exclusive role for the heart in the pathogenesis of HFpEF. 32, 33 As a whole, HFpEF has been extensively reviewed. 1–19 The present review focuses on 4 commonly encountered clinical phenotypes of HFpEF and their comorbid conditions (Figure). Therapeutic implications are discussed.