Upadhya Bharathi, Taffet George E, Cheng Che Ping, Kitzman Dalane W
Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Geriatrics and Cardiovascular Sciences, Baylor College of Medicine, Houston Methodist Hospital, Houston, TX, USA.
J Mol Cell Cardiol. 2015 Jun;83:73-87. doi: 10.1016/j.yjmcc.2015.02.025. Epub 2015 Mar 6.
Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults, particularly women, and is increasing in prevalence as the population ages. With morbidity and mortality on par with HF with reduced ejection fraction, it remains a most challenging clinical syndrome for the practicing clinician and basic research scientist. Originally considered to be predominantly caused by diastolic dysfunction, more recent insights indicate that HFpEF in older persons is typified by a broad range of cardiac and non-cardiac abnormalities and reduced reserve capacity in multiple organ systems. The globally reduced reserve capacity is driven by: 1) inherent age-related changes; 2) multiple, concomitant co-morbidities; 3) HFpEF itself, which is likely a systemic disorder. These insights help explain why: 1) co-morbidities are among the strongest predictors of outcomes; 2) approximately 50% of clinical events in HFpEF patients are non-cardiovascular; 3) clinical drug trials in HFpEF have been negative on their primary outcomes. Embracing HFpEF as a true geriatric syndrome, with complex, multi-factorial pathophysiology and clinical heterogeneity could provide new mechanistic insights and opportunities for progress in management. This article is part of a Special Issue entitled CV Aging.
射血分数保留的心力衰竭（HFpEF）是老年人尤其是女性中最常见的心力衰竭（HF）形式，并且随着人口老龄化，其患病率正在上升。由于其发病率和死亡率与射血分数降低的心力衰竭相当，它仍然是临床医生和基础研究科学家面临的最具挑战性的临床综合征。最初认为主要由舒张功能障碍引起，最近的研究表明，老年人的HFpEF具有广泛的心脏和非心脏异常以及多个器官系统储备能力下降的特点。全球储备能力下降是由以下因素驱动的：1）与年龄相关的固有变化；2）多种并存的合并症；3）HFpEF本身，它可能是一种全身性疾病。这些见解有助于解释为什么：1）合并症是预后的最强预测因素之一；2）HFpEF患者中约50%的临床事件是非心血管性的；3）HFpEF的临床药物试验在主要结局方面均为阴性。将HFpEF视为一种真正的老年综合征，具有复杂的多因素病理生理学和临床异质性，可能会为管理方面的进展提供新的机制见解和机会。本文是名为“心血管衰老”的特刊的一部分。
