Laboratory of Experimental Cardiology, Cardiology, UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, Netherlands.
Netherlands Heart Institute, 3511 EP, Utrecht, Netherlands.
J Cardiovasc Transl Res. 2021 Feb;14(1):63-74. doi: 10.1007/s12265-020-10026-3. Epub 2020 May 22.
The heart failure (HF) epidemic is growing and approximately half of the HF patients have heart failure with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous syndrome, characterized by a preserved left ventricular ejection fraction (LVEF ≥ 50%) with diastolic dysfunction, and is associated with high morbidity and mortality. Underlying comorbidities of HFpEF, i.e., hypertension, type 2 diabetes mellitus, obesity, and renal failure, lead to a systemic pro-inflammatory state, thereby affecting normal cardiac function. Increased inflammatory biomarkers predict incident HFpEF and are higher in patients with HFpEF as compared with heart failure with reduced ejection fraction (HFrEF). Randomized trials in HFpEF patients using traditional HF medication failed to demonstrate a clear benefit on hard endpoints (mortality and/or HF hospitalization). Therefore, therapies targeting underlying comorbidities and systemic inflammation in early HFpEF may provide better opportunities. Here, we provide an overview of the current state and future perspectives of immunomodulatory therapies for HFpEF.
心力衰竭（HF）的发病率正在上升，约有一半 HF 患者为射血分数保留的心力衰竭（HFpEF）。HFpEF 是一种异质性综合征，其特征为左心室射血分数（LVEF≥50%）保留伴舒张功能障碍，并与高发病率和死亡率相关。HFpEF 的潜在合并症，如高血压、2 型糖尿病、肥胖和肾衰竭，会导致全身炎症状态，从而影响正常的心脏功能。炎症生物标志物的升高预示着 HFpEF 的发生，且 HFpEF 患者的标志物水平高于射血分数降低的心力衰竭（HFrEF）患者。HFpEF 患者使用传统 HF 药物的随机试验未能在硬终点（死亡率和/或 HF 住院）上显示出明确的获益。因此，针对 HFpEF 早期潜在合并症和全身炎症的治疗方法可能提供更好的机会。在这里，我们概述了 HFpEF 的免疫调节治疗的现状和未来展望。
