Davidson Alexander, Raviendran Nivashinie, Murali Charisma Nair, Myint Phyo Kyaw
Ageing Clinical and Experimental Research, University of Aberdeen, Scotland, UK.
Royal College of Surgeon in Ireland-Perdana University, Selangor, Malaysia.
Ann Transl Med. 2020 Mar;8(6):395. doi: 10.21037/atm.2020.03.18.
Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence as the general population ages. Poorly managed heart failure symptoms of decompensated HFpEF is one of the most common reasons for prolonged hospital admission. The high rate of morbidity and mortality associated with HFpEF is compounded by a poor understanding of the underpinning pathophysiology. Randomized controlled trials have so far been unable to identify an evidence base for reducing morbidity and mortality in patients with HFpEF, although there is some evidence to support quality of life (QOL) improvement. In this review, we described the recent advances on the pathophysiological understanding of HFpEF, the current and emerging treatment strategies, and what this may mean for individual patients. Potential treatments for HFpEF were divided into their relative management strategies and the current evidence assessed for effect on HFpEF mortality, hospital admission frequency, and QOL improvement. Overall, the understanding of HFpEF pathophysiology is improving and has been made a priority in identifying potential therapeutic targets. There is growing evidence that patients with ejection fractions (EF) of less than 60% may obtain a mortality benefit from ACE-inhibitors, angiotensin-neprilysin inhibitors, Angiotensin Receptor Blockers, and Mineralocorticoid Receptor Antagonists. However, this covers only a small proportion of the HFpEF spectrum. Therefore, currently there are no universal treatment strategies recommended for HFpEF, and management should focus on an individualised approach and this should take into account the comorbidities of each patient.
随着普通人群老龄化，射血分数保留的心力衰竭（HFpEF）患病率正在上升。失代偿性HFpEF的心力衰竭症状管理不善是住院时间延长的最常见原因之一。对潜在病理生理学认识不足，加剧了与HFpEF相关的高发病率和死亡率。尽管有一些证据支持改善生活质量（QOL），但迄今为止，随机对照试验仍未能确定降低HFpEF患者发病率和死亡率的证据基础。在本综述中，我们描述了对HFpEF病理生理学认识的最新进展、当前和新出现的治疗策略，以及这对个体患者可能意味着什么。HFpEF的潜在治疗方法根据其相对管理策略进行划分，并评估了当前关于其对HFpEF死亡率、住院频率和生活质量改善影响的证据。总体而言，对HFpEF病理生理学的认识正在提高，并且已将其作为确定潜在治疗靶点的优先事项。越来越多的证据表明，射血分数（EF）低于60%的患者可能从血管紧张素转换酶抑制剂、血管紧张素-脑啡肽酶抑制剂、血管紧张素受体阻滞剂和盐皮质激素受体拮抗剂中获得死亡率益处。然而，这仅涵盖了HFpEF范围的一小部分。因此，目前没有针对HFpEF推荐的通用治疗策略，管理应侧重于个体化方法，这应考虑到每位患者的合并症。
