University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address: https://twitter.com/ambarish4786.
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Am Coll Cardiol. 2021 Sep 14;78(11):1166-1187. doi: 10.1016/j.jacc.2021.07.014.
Exercise intolerance (EI) is the primary manifestation of chronic heart failure with preserved ejection fraction (HFpEF), the most common form of heart failure among older individuals. The recent recognition that HFpEF is likely a systemic, multiorgan disorder that shares characteristics with other common, difficult-to-treat, aging-related disorders suggests that novel insights may be gained from combining knowledge and concepts from aging and cardiovascular disease disciplines. This state-of-the-art review is based on the outcomes of a National Institute of Aging-sponsored working group meeting on aging and EI in HFpEF. We discuss aging-related and extracardiac contributors to EI in HFpEF and provide the rationale for a transdisciplinary, "gero-centric" approach to advance our understanding of EI in HFpEF and identify promising new therapeutic targets. We also provide a framework for prioritizing future research, including developing a uniform, comprehensive approach to phenotypic characterization of HFpEF, elucidating key geroscience targets for treatment, and conducting proof-of-concept trials to modify these targets.
运动不耐受（EI）是射血分数保留的心力衰竭（HFpEF）的主要表现，这是老年人中最常见的心力衰竭类型。最近人们认识到，HFpEF 可能是一种系统性、多器官疾病，与其他常见的、难以治疗的与衰老相关的疾病具有共同特征，这表明从衰老和心血管疾病学科的知识和概念中可能获得新的见解。这篇最新综述是基于美国国立衰老研究所（National Institute of Aging）赞助的关于 HFpEF 中衰老和 EI 的工作组会议的结果。我们讨论了与衰老相关的和心脏外的因素对 HFpEF 中 EI 的影响，并为跨学科的“以衰老为中心”方法提供了依据，以推进我们对 HFpEF 中 EI 的理解，并确定有前途的新治疗靶点。我们还为未来的研究提供了一个框架，包括制定一种统一的、全面的 HFpEF 表型特征描述方法，阐明治疗的关键衰老科学靶点，并进行概念验证试验来改变这些靶点。
