Becher Peter Moritz, Fluschnik Nina, Blankenberg Stefan, Westermann Dirk
Peter Moritz Becher, Nina Fluschnik, Stefan Blankenberg, Dirk Westermann, Department of General and Interventional Cardiology, University Heart Center Eppendorf, 20246 Hamburg, Germany.
World J Cardiol. 2015 Sep 26;7(9):544-54. doi: 10.4330/wjc.v7.i9.544.
Heart failure (HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.
心力衰竭（HF）是老年人住院的主要原因，且随着西方国家人口老龄化，其患病率不断上升。流行病学报告显示，约50%有HF体征或症状的患者左心室射血分数保留。这种HF类型主要影响女性和患有其他合并症（如糖尿病、高血压和明显容量状态）的老年人。目前大多数治疗策略基于生活质量和临床HF症状减轻等发病率益处。几项大型随机对照试验显示，射血分数保留的HF患者的治疗结果令人失望。射血分数保留的HF的异质性，被认为是一种复杂综合征，似乎是主要原因之一。在此，我们概述了当前的管理策略，包括现有证据以及来自目前正在临床试验中的药物的新治疗方法，这些药物针对舒张功能障碍、变时性功能不全和危险因素管理。我们对最近未能改善射血分数保留的HF患者结局和生存率的临床试验进行了概述和解读。
