From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
J Card Fail. 2022 Jun;28(6):1016-1030. doi: 10.1016/j.cardfail.2021.12.013. Epub 2021 Dec 27.
Heart failure with preserved ejection fraction (HFpEF) is a growing epidemic owing to an increasingly obese and aging patient population. Making the diagnosis of HFpEF is often challenging because patients frequently have multiple comorbidities and alternative reasons for dyspnea and exercise intolerance, symptoms that are hallmark to the disease. Additionally, a universal diagnostic algorithm and definition of HFpEF is lacking. The treatment of HFpEF has been equally challenging, as there remain exceedingly few therapies show to improve survival in HFpEF and thus management to date has focused on intensive optimization of HFpEF risk factors. In this review, we highlight a stepwise approach to the diagnosis and treatment of HFpEF including (1) how to establish a clinical diagnosis of HFpEF, (2) when to refer for invasive diagnostic testing, (3) current treatment approaches to HFpEF including pharmacologic, nonpharmacologic, and risk factor modification interventions, and (4) when to refer to a dedicated HFpEF center or advanced heart failure specialist. With this systematic stepwise approach to HFpEF diagnosis and management, we aim to improve accurate diagnosis of the disease as well as raise awareness of available therapeutic options for this challenging patient population.
射血分数保留的心力衰竭（HFpEF）是一种日益流行的疾病，这归因于肥胖和老龄化患者人群的不断增加。HFpEF 的诊断通常具有挑战性，因为患者经常患有多种合并症和呼吸困难及运动耐量降低的其他替代原因，而这些症状是该疾病的标志性特征。此外，还缺乏普遍的诊断算法和 HFpEF 的定义。HFpEF 的治疗同样具有挑战性，因为目前仅有极少数疗法显示可以改善 HFpEF 的生存率，因此迄今为止的治疗重点一直是集中优化 HFpEF 的危险因素。在这篇综述中，我们强调了 HFpEF 的诊断和治疗的逐步方法，包括：(1) 如何建立 HFpEF 的临床诊断，(2) 何时进行有创诊断性检查，(3) 目前 HFpEF 的治疗方法，包括药物、非药物和危险因素修正干预，以及 (4) 何时转介至专门的 HFpEF 中心或高级心力衰竭专家。通过这种系统的 HFpEF 诊断和管理的逐步方法，我们旨在提高对该疾病的准确诊断，并提高对这一具有挑战性的患者群体的现有治疗选择的认识。
