Heart failure with preserved ejection fraction: mechanisms, clinical features, and therapies.
Heart failure with preserved ejection fraction: mechanisms, clinical features, and therapies.
复制标题
DOI：
10.1161/circresaha.115.302922
复制
发表时间：
2014-06-20
影响因子：
20.1
通讯作者：
Kass DA
中科院分区：
文献类型：
--
作者：
Sharma K;Kass DA
包括心力衰竭症状但左心室射血分数不降低的临床综合征，例如射血分数保留的心力衰竭（HFpEF），在发达国家日益成为HF的主要形式，并且很快达到流行病的比例。它仍然是临床医生和科学家最具挑战性的临床综合征之一，有许多涉及心脏和其他器官的机制，以及与常见共病的复杂相互作用。重要的是，其发病率和死亡率与心力衰竭和射血分数降低相当，并且随着失败治疗名单的不断增加，HFpEF显然代表了一个主要的未满足的医疗需求。该领域非常需要一种更统一的方法来定义和观察综合征，这种方法涉及综合和储备病理生理学，而不仅仅是与心脏相关的病理生理学。我们需要反思先前的治疗失败及其所提供的信息，并重新指导我们的方法，可能是如何看待这种疾病的范式转变。成功将需要临床医生，翻译研究人员和基础生理学家之间的互动。在这里，我们回顾了HFpEF的最新转化和临床研究，对其不断发展的人口统计学和流行病学，多器官缺陷的作用，涉及心脏和其他器官的潜在机制，临床试验和未来的发展方向进行了展望。
The clinical syndrome comprised of heart failure symptoms but with a left ventricular ejection fraction that is not diminished, e.g. heart failure with a preserved ejection fraction (HFpEF), is increasingly the predominant form of HF in the developed world, and soon to reach epidemic proportions. It remains among the most challenging of clinical syndromes for the practicing clinician and scientist alike, with a multitude of proposed mechanisms involving the heart and other organs and complex interplay with common co-morbidities. Importantly, its morbidity and mortality is on par with heart failure and a reduced ejection fraction, and as the list of failed treatments continues to grow, HFpEF clearly represents a major unmet medical need. The field is greatly in need of a more unified approach to its definition and view of the syndrome that engages integrative and reserve pathophysiology beyond that related to the heart alone. We need to reflect on prior treatment failures and the message this is providing, and re-direct our approaches likely with a paradigm shift in how the disease is viewed. Success will require interactions between clinicians, translational researchers, and basic physiologists. Here, we review recent translational and clinical research into HFpEF, give perspectives on its evolving demographics and epidemiology, the role of multi-organ deficiencies, potential mechanisms that involve the heart and other organs, clinical trials, and future directions.