Kinugasa Yoshiharu, Yamamoto Kazuhiro
Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan.
Heart. 2017 Feb;103(3):184-189. doi: 10.1136/heartjnl-2016-309995. Epub 2016 Dec 9.
Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to stressors. Frailty is often accompanied by heart failure with preserved ejection fraction (HFpEF), and frailty is likely to affect its clinical features and outcomes. Frail patients with HFpEF are frequently associated with sarcopenia (ie, muscle loss and weakness), which is a major component of the pathophysiology of frailty. Sarcopenia is a systemic skeletal muscle disease that impairs the function of limb skeletal muscles, as well as respiratory muscles, and this results in further functional decline. In addition, sarcopenia may contribute to cardiovascular remodelling and dysfunction, leading to the development of HFpEF through several metabolic and endocrine abnormalities. Although there is no established strategy for frail patients with HFpEF, a multidisciplinary approach, including various types of muscular training and nutritional intervention, may provide beneficial effects for these patients.
衰弱是一种临床状态，即个体在暴露于应激源时，出现依赖性增加和/或死亡率上升的易感性增加。衰弱常伴有射血分数保留的心力衰竭（HFpEF），且衰弱可能会影响其临床特征和预后。HFpEF的衰弱患者常伴有肌肉减少症（即肌肉流失和无力），这是衰弱病理生理学的主要组成部分。肌肉减少症是一种全身性骨骼肌疾病，会损害肢体骨骼肌以及呼吸肌的功能，进而导致功能进一步下降。此外，肌肉减少症可能会导致心血管重塑和功能障碍，通过多种代谢和内分泌异常导致HFpEF的发生。虽然目前尚无针对HFpEF衰弱患者的既定策略，但多学科方法，包括各种类型的肌肉训练和营养干预，可能会对这些患者产生有益影响。
