Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, 10029, USA.
Cardiovasc Drugs Ther. 2023 Oct;37(5):989-996. doi: 10.1007/s10557-022-07371-7. Epub 2022 Aug 3.
Results from DELIVER trial and publication of EMPEROR-Preserved with sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with heart failure (HF) with ejection fraction (EF) > 40% represent a significant step forward in the treatment of HF with preserved EF (HFpEF). However, detailed analysis and attenuation of effect at higher EF levels have sparked some doubts about whether empagliflozin is effective across the entire spectrum of EF. HFpEF is no longer considered as one disease entity, but has been reconceptualized as a heterogenous group of phenotypes with derangements in multiple organ systems, driven by comorbidities. This heterogeneity suggests that it should not be considered as a single group in terms of treatment goals or clinical approach. Future research at the higher range of EF should ideally tailor investigations for unequivocally preserved EF (> 50%), consider the dynamic nature of EF over time, and use low-variability imaging techniques such as CMR. Furthermore, classifications based on pathophysiology and HF phenotypes beyond the EF construct will shape the design of future trials and help narrow down groups of patients who may respond to personalized treatment.
DELIVER 试验的结果以及钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂在射血分数（EF）>40%的心衰（HF）患者中的应用的发表，代表了 HF 伴保留射血分数（HFpEF）治疗的重大进展。然而，对更高 EF 水平的效果的详细分析和减弱引发了一些关于依帕列净是否在整个 EF 范围内有效的怀疑。HFpEF 不再被认为是一种单一的疾病实体，而是被重新概念化为一组具有多种器官系统功能障碍的异质表型，这些表型由合并症驱动。这种异质性表明，就治疗目标或临床方法而言，不应该将其视为一个单一的群体。未来在更高 EF 范围内的研究理想情况下应针对明确保留的 EF（>50%）进行调整调查，考虑 EF 随时间的动态变化，并使用 CMR 等低变异性成像技术。此外，基于 EF 结构之外的病理生理学和 HF 表型的分类将为未来试验的设计提供指导，并有助于缩小可能对个性化治疗有反应的患者群体。
