Miranda-Silva Daniela, Lima Tânia, Rodrigues Patrícia, Leite-Moreira Adelino, Falcão-Pires Inês
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
Heart Fail Rev. 2021 May;26(3):453-478. doi: 10.1007/s10741-020-10042-0. Epub 2021 Jan 7.
Heart failure with preserved ejection fraction (HFpEF) is a multifaceted syndrome with a complex aetiology often associated with several comorbidities, such as left ventricle pressure overload, diabetes mellitus, obesity, and kidney disease. Its pathophysiology remains obscure mainly due to the complex phenotype induced by all these associated comorbidities and to the scarcity of animal models that adequately mimic HFpEF. Increased oxidative stress, inflammation, and endothelial dysfunction are currently accepted as key players in HFpEF pathophysiology. However, we have just started to unveil HFpEF complexity and the role of calcium handling, energetic metabolism, and mitochondrial function remain to clarify. Indeed, the enlightenment of such cellular and molecular mechanisms represents an opportunity to develop novel therapeutic approaches and thus to improve HFpEF treatment options. In the last decades, the number of research groups dedicated to studying HFpEF has increased, denoting the importance and the magnitude achieved by this syndrome. In the current technological and web world, the amount of information is overwhelming, driving us not only to compile the most relevant information about the theme but also to explore beyond the tip of the iceberg. Thus, this review aims to encompass the most recent knowledge related to HFpEF or HFpEF-associated comorbidities, focusing mainly on myocardial metabolism, oxidative stress, and energetic pathways.
射血分数保留的心力衰竭（HFpEF）是一种多方面的综合征，病因复杂，常与多种合并症相关，如左心室压力过载、糖尿病、肥胖和肾脏疾病。其病理生理学仍不明确，主要是由于所有这些相关合并症所诱导的复杂表型，以及缺乏充分模拟HFpEF的动物模型。氧化应激增加、炎症和内皮功能障碍目前被认为是HFpEF病理生理学的关键因素。然而，我们才刚刚开始揭示HFpEF的复杂性，钙处理、能量代谢和线粒体功能的作用仍有待阐明。事实上，阐明这些细胞和分子机制代表了开发新治疗方法的机会，从而改善HFpEF的治疗选择。在过去几十年里，致力于研究HFpEF的研究小组数量有所增加，这表明该综合征的重要性和影响力。在当前的技术和网络世界中，信息量巨大，这不仅促使我们汇编有关该主题的最相关信息，还促使我们探索冰山一角之外的内容。因此，本综述旨在涵盖与HFpEF或HFpEF相关合并症的最新知识，主要关注心肌代谢、氧化应激和能量途径。
