Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Str., 66421, Homburg/Saar, Germany.
Herz. 2022 Aug;47(4):332-339. doi: 10.1007/s00059-022-05119-5. Epub 2022 May 6.
The diagnosis and therapy of heart failure with preserved ejection fraction (HFpEF) remain challenging. Currently, there are ongoing discussions on whether the diagnosis of HFpEF should be based solely on left ventricular ejection fraction, which may not account for the heterogeneity of HFpEF syndrome. This aspect has been addressed by the recently proposed HFA-PEFF and the H2FPEF algorithms, which take numerous diagnostic modalities into account to establish the diagnosis of HFpEF. Moreover, this review focuses on the adequate treatment of comorbidities and risk factors in HFpEF that should be an essential part of any HFpEF therapy. Furthermore, the management of fluid level in HFpEF patients is pointed out, as it plays an important role in symptom control. In addition, the value of LCZ696 therapy in HFpEF is discussed. Although LCZ696 had neutral effects in the large PARAGON-HF trial, it had previously been granted an extended indication by the Food and Drug Administration. Since the publication of the EMPEROR-Preserved trial, empagliflozin now represents the first drug to significantly improve the prognosis of HFpEF patients. Therefore, the role of SGLT2 inhibitors in HFpEF management is highlighted. Overall, this review aims to enhance the knowledge on the diagnostic processes and best treatments available for HFpEF patients.
射血分数保留型心力衰竭（HFpEF）的诊断和治疗仍然具有挑战性。目前，人们正在讨论是否应该仅根据左心室射血分数来诊断 HFpEF，因为这可能无法解释 HFpEF 综合征的异质性。最近提出的 HFA-PEFF 和 H2FPEF 算法已经解决了这一方面的问题，这些算法考虑了许多诊断方式来确定 HFpEF 的诊断。此外，本综述重点介绍了 HFpEF 中合并症和危险因素的适当治疗，这应该是任何 HFpEF 治疗的重要组成部分。此外，还指出了 HFpEF 患者液体水平的管理，因为它在控制症状方面起着重要作用。此外，还讨论了 LCZ696 在 HFpEF 中的治疗价值。尽管 LCZ696 在大型 PARAGON-HF 试验中效果中性，但此前已被美国食品和药物管理局扩展了适应证。自 EMPEROR-Preserved 试验发表以来，恩格列净现在是第一个显著改善 HFpEF 患者预后的药物。因此，强调了 SGLT2 抑制剂在 HFpEF 管理中的作用。总的来说，本综述旨在提高对 HFpEF 患者诊断过程和最佳治疗方法的认识。
