Upadhya Bharathi, Haykowsky Mark J, Eggebeen Joel, Kitzman Dalane W
Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA.
Curr Heart Fail Rep. 2015 Jun;12(3):205-14. doi: 10.1007/s11897-015-0257-5.
Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults. The primary chronic symptom in patients with HFpEF, even when well compensated, is severe exercise intolerance. Cardiac and peripheral functions contribute equally to exercise intolerance in HFpEF, though the latter has been the focus of fewer studies. Of note, multiple studies with exercise training have shown that exercise intolerance can improve significantly in the absence of improvements in exercise cardiac output, indicating a role of peripheral, noncardiac adaptations. In addition, clinical drug trials performed to date in HFpEF, all of which have focused on influencing cardiovascular function, have not been positive on primary clinical outcomes and most have not improved exercise capacity. Mounting evidence indicates that sarcopenic obesity, characterized by the coexistence of excess fat mass and decreased muscle mass, could contribute to the pathophysiology of exercise intolerance in older HFpEF patients and may provide avenues for novel treatments.
射血分数保留的心力衰竭（HFpEF）是老年人中最常见的心力衰竭（HF）形式。HFpEF患者的主要慢性症状，即使在病情得到良好代偿时，也是严重的运动不耐受。心脏和外周功能对HFpEF患者的运动不耐受的影响相同，尽管后者的研究较少。值得注意的是，多项运动训练研究表明，在运动心输出量没有改善的情况下，运动不耐受也能显著改善，这表明外周非心脏适应性变化发挥了作用。此外，迄今为止在HFpEF中进行的临床药物试验均聚焦于影响心血管功能，对主要临床结局均未取得阳性结果，且大多数试验并未改善运动能力。越来越多的证据表明，以脂肪量过多和肌肉量减少并存为特征的肌少症性肥胖，可能在老年HFpEF患者运动不耐受的病理生理过程中起作用，并可能为新的治疗方法提供途径。
