Ageev F T, Ovchinnikov A G
FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation.
Kardiologiia. 2018 Dec 25;58(12S):4-10. doi: 10.18087/cardio.2609.
The article discusses the clinical expedience of isolating into a separate classification subgroup of patients with heart failure and a mid‑range ejection fraction (EF) of 40-49 %. Analysis of studies 2017-2018 focusing on the issue of patients with mid‑range LV EF showed that this subgroup is highly heterogenous and by some clinical and demographic parameters takes an intermediate position between heart failure (HF) patients with reduced (<40 %) and preserved (>50 %) LV EF. However, patients with mid‑range LV EF positively respond to beta‑blocker and RAAS inhibitor therapy, and their response is close to that of patients with reduced LV EF. This is a principal difference between patients with mid‑range and preserved LV EF who generally do not display any beneficial effect of such therapy. One of the major causes for such difference is a dissimilarity of HF etiology and, hence, pathogenesis in patients with reduced and mid‑range LV EF: primarily IHD (so‑called "ischemic" phenotype) in patients with reduced and mid‑range LV EF and non‑cardiac causes ("non‑ischemic" phenotype) in patients with preserved LV EF. Since the nonischemic phenotype is also rather common among patients with mid‑range LV EF a new HF classification should definitely indicate, in addition to LV EF, the clinical phenotype of disease, which is particularly important for patients with mid‑range LV EF of 40-49 %. Further studies should focus on variants of HF clinical phenotypes.
本文讨论了将射血分数（EF）处于40%-49%的心力衰竭患者单独划分到一个分类亚组中的临床便利性。对2017 - 2018年关于中度左室射血分数患者问题的研究分析表明，该亚组具有高度异质性，并且在一些临床和人口统计学参数方面处于左室射血分数降低（<40%）和保留（>50%）的心力衰竭患者之间的中间位置。然而，中度左室射血分数患者对β受体阻滞剂和肾素 - 血管紧张素系统（RAAS）抑制剂治疗有积极反应，且他们的反应与左室射血分数降低的患者相近。这是中度左室射血分数患者与左室射血分数保留患者之间的主要区别，后者通常未显示出此类治疗的任何有益效果。造成这种差异的主要原因之一是左室射血分数降低和中度患者心力衰竭病因及发病机制的不同：左室射血分数降低和中度患者主要为缺血性心脏病（所谓的“缺血性”表型），而左室射血分数保留患者为非心脏病因（“非缺血性”表型）。由于非缺血性表型在中度左室射血分数患者中也相当常见，除左室射血分数外，新的心力衰竭分类肯定应指明疾病的临床表型，这对射血分数为40%-49%的中度左室射血分数患者尤为重要。进一步的研究应聚焦于心力衰竭临床表型的变体。
