Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts.
JACC Heart Fail. 2018 Dec;6(12):975-982. doi: 10.1016/j.jchf.2018.09.006.
Heart failure with preserved ejection fraction (HFpEF) is common, increasing in prevalence, and refractory to available pharmacotherapies. Our understanding of HFpEF has evolved from a disorder of diastolic dysfunction to a constellation of physiologic impairments that lead to elevated left ventricular filling pressures and exercise intolerance. Accordingly, the therapeutic and preventive focus has shifted to identifying lifestyle factors that may have more pleotropic effects on the pathophysiologic mechanisms that define HFpEF. Recent studies have demonstrated that physical inactivity, low fitness, and obesity are potential modifiable targets for prevention as well as management of HFpEF. In this review, we have discussed the emerging epidemiological, mechanistic, and clinical evidence that support the role of these lifestyle factors as key determinants of development and progression of HFpEF. We also summarize the available evidence and major knowledge gaps with regard to developing exercise training and weight loss as unique and effective therapeutic strategies for management of HFpEF.
射血分数保留的心力衰竭（HFpEF）较为常见，其患病率不断增加，且对现有药物治疗具有抗药性。我们对 HFpEF 的认识已经从舒张功能障碍的疾病演变为一系列导致左心室充盈压升高和运动不耐受的生理功能障碍。因此，治疗和预防的重点已经转移到确定可能对定义 HFpEF 的病理生理机制具有更广泛作用的生活方式因素。最近的研究表明，身体活动不足、低健康水平和肥胖症可能是预防和管理 HFpEF 的可改变目标。在这篇综述中，我们讨论了支持这些生活方式因素作为 HFpEF 发生和发展的关键决定因素的新兴流行病学、机制和临床证据。我们还总结了关于将运动训练和减肥作为 HFpEF 管理的独特和有效治疗策略的现有证据和主要知识空白。
