Cardiology Division, Department of Medicine, Emory University, Atlanta, Georgia, USA.
J Am Coll Cardiol. 2012 Oct 16;60(16):1455-69. doi: 10.1016/j.jacc.2011.11.082. Epub 2012 Sep 19.
Outcomes for heart failure (HF) patients remain suboptimal. No known therapy improves mortality in acute HF and HF with preserved ejection fraction; the most recent HF trial results have been negative or neutral. Improvement in surrogate markers has not necessarily translated into better outcomes. To translate breakthroughs with potential therapies into clinical benefit, a better understanding of the pathophysiology establishing the foundation of benefit is necessary. Vascular function plays a central role in the development and progression of HF. Endothelial function and nitric oxide availability affect myocardial function, systemic and pulmonary hemodynamics, and coronary and renal circulation. Arterial stiffness modulates ventricular loading conditions and diastolic function, key components of HF with preserved ejection. Endothelial function and arterial stiffness may therefore serve as important physiological targets for new HF therapies and facilitate patient selection for improved application of existing agents.
心力衰竭（HF）患者的预后仍然不理想。目前尚无已知的疗法可以改善急性心力衰竭和射血分数保留的心力衰竭患者的死亡率；最近的心力衰竭试验结果均为阴性或中性。替代标志物的改善不一定转化为更好的结局。为了将潜在治疗方法的突破转化为临床获益，需要更好地了解确定获益基础的病理生理学。血管功能在心力衰竭的发展和进展中起着核心作用。内皮功能和一氧化氮的可用性影响心肌功能、全身和肺血流动力学以及冠状动脉和肾脏循环。动脉僵硬度调节心室负荷条件和舒张功能，这是射血分数保留心力衰竭的关键组成部分。因此，内皮功能和动脉僵硬度可以作为新的心力衰竭治疗方法的重要生理靶点，并有助于为改善现有药物的应用选择患者。
