Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Am Coll Cardiol. 2017 Feb 7;69(5):556-569. doi: 10.1016/j.jacc.2016.10.078.
Little is known about specific modes of death in patients with heart failure with preserved ejection fraction (HFpEF). Herein, the authors critically appraise the current state of data and offer potential future directions. They conducted a systematic review of 1,608 published HFpEF papers from January 1, 1985, to December 31, 2015, which yielded 8 randomized clinical trials and 24 epidemiological studies with mode-of-death data. Noncardiovascular modes of death represent an important competing risk in HFpEF. Although sudden death accounted for ∼25% to 30% of deaths in trials, its definition is nonspecific; it is unclear what proportion represents arrhythmic deaths. Moving forward, reporting and definitions of modes of death must be standardized and tailored to the HFpEF population. Broad-scale systematic autopsies and long-term rhythm monitoring may clarify the underlying pathology and mechanisms driving mortal events. There is an unmet need for a longitudinal multicenter, global registry of patients with HFpEF to map its natural history.
对于射血分数保留的心力衰竭（HFpEF）患者的具体死亡模式知之甚少。在此，作者批判性地评估了现有数据的状况，并提出了潜在的未来方向。他们对 1985 年 1 月 1 日至 2015 年 12 月 31 日期间发表的 1608 篇 HFpEF 论文进行了系统回顾，其中包括 8 项随机临床试验和 24 项具有死亡模式数据的流行病学研究。非心血管死亡模式是 HFpEF 的一个重要竞争风险。尽管在试验中，猝死约占死亡人数的 25%至 30%，但其定义不明确；尚不清楚有多少比例代表心律失常死亡。今后，必须对死亡模式的报告和定义进行标准化，并针对 HFpEF 人群进行调整。大规模系统尸检和长期心律监测可能阐明导致致命事件的潜在病理和机制。需要对 HFpEF 患者进行一项前瞻性、多中心、全球性登记研究，以绘制其自然病史。
