Center for Molecular and Vascular Biology, KU Leuven, Herestraat 49, bus 911, 3000 Leuven, Belgium.
Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands.
Cells. 2020 Jan 18;9(1):242. doi: 10.3390/cells9010242.
Heart failure (HF) is the most rapidly growing cardiovascular health burden worldwide. HF can be classified into three groups based on the percentage of the ejection fraction (EF): heart failure with reduced EF (HFrEF), heart failure with mid-range-also called mildly reduced EF- (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). HFmrEF can progress into either HFrEF or HFpEF, but its phenotype is dominated by coronary artery disease, as in HFrEF. HFrEF and HFpEF present with differences in both the development and progression of the disease secondary to changes at the cellular and molecular level. While recent medical advances have resulted in efficient and specific treatments for HFrEF, these treatments lack efficacy for HFpEF management. These differential response rates, coupled to increasing rates of HF, highlight the significant need to understand the unique pathogenesis of HFrEF and HFpEF. In this review, we summarize the differences in pathological development of HFrEF and HFpEF, focussing on disease-specific aspects of inflammation and endothelial function, cardiomyocyte hypertrophy and death, alterations in the giant spring titin, and fibrosis. We highlight the areas of difference between the two diseases with the aim of guiding research efforts for novel therapeutics in HFrEF and HFpEF.
心力衰竭（HF）是全球心血管健康负担增长最快的疾病。根据射血分数（EF）的百分比，HF 可分为三组：射血分数降低的心力衰竭（HFrEF）、射血分数中间值也称为轻度降低的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）。HFmrEF 可进展为 HFrEF 或 HFpEF，但由于细胞和分子水平的变化，其表型与 HFrEF 一样以冠状动脉疾病为主。由于在疾病的发展和进展方面存在差异，HFrEF 和 HFpEF 在临床表现和治疗方面存在差异。尽管最近的医学进展为 HFrEF 提供了有效和特定的治疗方法，但这些治疗方法对 HFpEF 的管理效果不佳。这些不同的反应率，加上 HF 发生率的增加，突出表明有必要深入了解 HFrEF 和 HFpEF 的独特发病机制。在这篇综述中，我们总结了 HFrEF 和 HFpEF 的病理发展差异，重点介绍了炎症和内皮功能、心肌细胞肥大和死亡、巨大春肌球蛋白的改变以及纤维化等疾病特异性方面。我们强调了这两种疾病之间的差异领域，旨在为 HFrEF 和 HFpEF 的新型治疗方法指导研究工作。
