Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA.
Am J Med Sci. 2013 Aug;346(2):129-36. doi: 10.1097/MAJ.0b013e31828c586e.
Heart failure (HF) with a normal left ventricular (LV) ejection fraction (HFNEF) occurs in 40-71% of patients with HF and carries a prognosis similar to that of HF with a reduced LV ejection fraction (LVEF). The pathophysiology of HFNEF is distinct from that of HF with a reduced LVEF and is characterized by impaired relaxation of myocardium, LV stiffness and, in many cases, increased arterial stiffness. Systemic hypertension accounts for most cases of HFNEF in the United States. Those with HFNEF tend to be older and obese. Diabetes mellitus and atrial fibrillation occur with disproportionately high frequency in HFNEF. The diagnosis of HFNEF requires the presence of symptoms or signs of HF, a normal or near-normal LVEF and evidence of LV diastolic dysfunction based on cardiac catheterization or Doppler echocardiographic techniques and/or elevation of plasma natriuretic peptide levels. Current guidelines for management of HFNEF include control of systolic and diastolic hypertension, control of the ventricular rate in patients with atrial fibrillation and judicious use of diuretics. In selected cases, coronary revascularization or restoration of sinus rhythm in those with atrial fibrillation may be indicated. To date, no drug or drug group has consistently improved survival in HFNEF. For this reason and because of the poor long-term prognosis, preventative measures and effective treatment of underlying causes and precipitating factors are particularly important in avoiding HF exacerbations in patients with HFNEF.
心力衰竭（HF）伴有正常左心室（LV）射血分数（HFNEF）发生在 40-71%的 HF 患者中，其预后与 LV 射血分数降低的 HF（LVEF）相似。HFNEF 的病理生理学与 LVEF 降低的 HF 不同，其特征为心肌舒张功能障碍、LV 僵硬度增加，在许多情况下还伴有动脉僵硬度增加。在美国，大多数 HFNEF 是由系统性高血压引起的。HFNEF 患者往往年龄较大且肥胖。HFNEF 中糖尿病和心房颤动的发生率异常高。HFNEF 的诊断需要存在 HF 的症状或体征、正常或接近正常的 LVEF 以及基于心导管或多普勒超声心动图技术和/或升高的血浆利钠肽水平的 LV 舒张功能障碍的证据。HFNEF 管理的现行指南包括控制收缩期和舒张期高血压、控制心房颤动患者的心室率以及谨慎使用利尿剂。在某些情况下，可能需要进行冠状动脉血运重建或恢复心房颤动患者的窦性节律。迄今为止，没有任何药物或药物组能够一致改善 HFNEF 的生存率。出于这个原因，以及由于预后较差，预防措施和有效治疗潜在病因和诱发因素在避免 HFNEF 患者 HF 恶化方面尤为重要。
