Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
Mayo Clinic, Rochester, MN (B.A.B., M.M.R.).
Circulation. 2020 Mar 24;141(12):1001-1026. doi: 10.1161/CIRCULATIONAHA.119.041886. Epub 2020 Mar 23.
Heart failure with preserved ejection fraction (HFpEF), a major public health problem that is rising in prevalence, is associated with high morbidity and mortality and is considered to be the greatest unmet need in cardiovascular medicine today because of a general lack of effective treatments. To address this challenging syndrome, the National Heart, Lung, and Blood Institute convened a working group made up of experts in HFpEF and novel research methodologies to discuss research gaps and to prioritize research directions over the next decade. Here, we summarize the discussion of the working group, followed by key recommendations for future research priorities. There was uniform recognition that HFpEF is a highly integrated, multiorgan, systemic disorder requiring a multipronged investigative approach in both humans and animal models to improve understanding of mechanisms and treatment of HFpEF. It was recognized that advances in the understanding of basic mechanisms and the roles of inflammation, macrovascular and microvascular dysfunction, fibrosis, and tissue remodeling are needed and ideally would be obtained from (1) improved animal models, including large animal models, which incorporate the effects of aging and associated comorbid conditions; (2) repositories of deeply phenotyped physiological data and human tissue, made accessible to researchers to enhance collaboration and research advances; and (3) novel research methods that take advantage of computational advances and multiscale modeling for the analysis of complex, high-density data across multiple domains. The working group emphasized the need for interactions among basic, translational, clinical, and epidemiological scientists and across organ systems and cell types, leveraging different areas or research focus, and between research centers. A network of collaborative centers to accelerate basic, translational, and clinical research of pathobiological mechanisms and treatment strategies in HFpEF was discussed as an example of a strategy to advance research progress. This resource would facilitate comprehensive, deep phenotyping of a multicenter HFpEF patient cohort with standardized protocols and a robust biorepository. The research priorities outlined in this document are meant to stimulate scientific advances in HFpEF by providing a road map for future collaborative investigations among a diverse group of scientists across multiple domains.
射血分数保留的心力衰竭(HFpEF)是一种主要的公共卫生问题,其患病率正在上升,与高发病率和死亡率相关,并且由于缺乏有效的治疗方法,被认为是当今心血管医学中最大的未满足需求。为了应对这一具有挑战性的综合征,美国国立心肺血液研究所召集了一个由 HFpEF 专家和新的研究方法学专家组成的工作组,讨论研究差距,并确定未来十年的研究重点方向。在这里,我们总结了工作组的讨论,并提出了未来研究重点的关键建议。工作组一致认为,HFpEF 是一种高度综合的多器官、系统性疾病,需要在人类和动物模型中采用多管齐下的研究方法,以提高对 HFpEF 机制和治疗的理解。人们认识到,需要深入了解基本机制以及炎症、大血管和微血管功能障碍、纤维化和组织重塑的作用等方面的进展,并且最好能够从以下方面获得这些进展:(1)改进的动物模型,包括能够纳入衰老和相关合并症影响的大型动物模型;(2)深入表型的生理数据和人类组织库,这些资源可以供研究人员使用,以加强合作和研究进展;(3)利用计算进展和多尺度建模进行复杂、高密度数据的跨多个领域分析的新研究方法。工作组强调了基础、转化、临床和流行病学科学家之间以及跨器官系统和细胞类型之间相互作用的必要性,利用不同的研究领域或重点,并在研究中心之间进行合作。工作组讨论了建立一个协作中心网络,以加速 HFpEF 的病理生物学机制和治疗策略的基础、转化和临床研究,以此作为推进研究进展的一种策略。该资源将有助于对多中心 HFpEF 患者队列进行全面、深入的表型分析,并建立一个标准化的协议和强大的生物样本库。本文件中概述的研究重点旨在通过为跨越多个领域的不同类型科学家之间的未来合作研究提供路线图,来促进 HFpEF 的科学进展。