Lam Carolyn S P, Solomon Scott D
National Heart Centre Singapore and Duke-National University of Singapore, Singapore; University Medical Centre Groningen, Groningen, the Netherlands.
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2021 Jun 29;77(25):3217-3225. doi: 10.1016/j.jacc.2021.04.070.
The recent U.S. Food and Drug Administration expanded indication for sacubitril/valsartan introduces a new potential taxonomy for heart failure, with no reference to "preserved" ejection fraction but referring to "below normal" ejection fraction as those most likely to benefit. This review summarizes the evolution of nomenclature in heart failure and examines evidence showing that patients with ejection fraction in the "mid range" may benefit from neurohormonal blockade similar to those with more severely reduced (<40%) ejection fraction. Furthermore, prominent sex differences have been observed wherein the benefit of neurohormonal blockade appears to extend to a higher ejection fraction range in women compared to men. Based on emerging evidence, revised nomenclature is proposed defining heart failure with "reduced" (<40%), "mildly reduced," and "normal" (≥55% in men, ≥60% in women) ejection fraction. Such nomenclature signals consideration of potentially beneficial therapies in the largest group of patients with reduced or mildly reduced ejection fraction.
美国食品药品监督管理局最近扩大了沙库巴曲缬沙坦的适应症，引入了一种心力衰竭的新潜在分类法，未提及“保留”射血分数，而是将“低于正常”射血分数视为最可能受益的人群。本综述总结了心力衰竭命名法的演变，并审视了证据，这些证据表明“中等范围”射血分数的患者可能与射血分数严重降低（<40%）的患者一样，从神经激素阻断中获益。此外，还观察到了显著的性别差异，即与男性相比，神经激素阻断对女性的益处似乎延伸至更高的射血分数范围。基于新出现的证据，建议修订命名法，将心力衰竭定义为射血分数“降低”（<40%）、“轻度降低”和“正常”（男性≥55%，女性≥60%）。这种命名法表明要考虑对射血分数降低或轻度降低的最大患者群体采用潜在有益的治疗方法。
