Çavuşoğlu Yüksel, Çelik Ahmet, Altay Hakan, Nalbantgil Sanem, Özden Özge, Temizhan Ahmet, Ural Dilek, Ünlü Serkan, Yılmaz Mehmet Birhan, Zoghi Mehdi
Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Eskişehir.
Mersin Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Mersin.
Turk Kardiyol Dern Ars. 2022 May;50(Supp1):S1-S34. doi: 10.5543/tkda.2022.S1.
Heart failure (HF) has been classified as reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) by the recent HF guidelines. In addition, HF with improved ejection fraction has been defined as a subgroup of HFrEF. In HFrEF, diagnostic workup and evidence-based pharmacological and device-based therapies have been well established. However, HFpEF, which comprises almost half of the HF population, represents significant uncertainties regarding its pathophysiology, clinical phenotypes, diagnosis and treatment. Diagnostic criteria of HFpEF have been changed a few times over the years and still remained a matter of debate. New paradigms including a prominent role of co-morbidities, inflammation, endothelial dysfunction have been proposed in its pathophysiology. As a complex, multifactorial syndrome HFpEF consists of many overlapping clinical and hemodynamic phenotypes. In contrast to HFrEF, clinical outcomes of HFpEF have not improved over the last decades due to lack of proven effective therapies. Although HFrEF and HFpEF have different clinical spectrums and proposed pathophysiological mechanisms, there is no clear defining syndrome postulated for HFmrEF. Clinical characteristics and risk factors of HFmrEF overlap with HFrEF and HFpEF. HFmrEF is also referred as a transitional zone for dynamic temporal changes in EF. So, HFpEF and HFmrEF, both namely HF with non-reduced ejection fraction (HF-NEF), have some challenges in the management of HF. The purpose of this paper is to provide a comprehensive review including epidemiology, pathophysiology, clinical presentation and phenotypes of HF-NEF and to guide clinicians for the diagnosis and therapeutic approaches based on the available data in the literature.
根据最新的心衰指南，心力衰竭（HF）已被分类为射血分数降低的心衰（HFrEF）、射血分数轻度降低的心衰（HFmrEF）和射血分数保留的心衰（HFpEF）。此外，射血分数改善的心衰已被定义为HFrEF的一个亚组。在HFrEF中，诊断检查以及基于证据的药物和器械治疗已经得到了很好的确立。然而，HFpEF几乎占心衰患者总数的一半，其病理生理学、临床表型、诊断和治疗仍存在重大不确定性。多年来，HFpEF的诊断标准几经变化，至今仍是一个有争议的问题。其病理生理学中提出了一些新的范式，包括共病、炎症、内皮功能障碍的突出作用。作为一种复杂的多因素综合征，HFpEF由许多重叠的临床和血流动力学表型组成。与HFrEF不同，由于缺乏经证实有效的治疗方法，HFpEF的临床结局在过去几十年中并未得到改善。尽管HFrEF和HFpEF具有不同的临床谱和提出的病理生理机制，但对于HFmrEF尚无明确的定义综合征。HFmrEF的临床特征和危险因素与HFrEF和HFpEF重叠。HFmrEF也被称为射血分数动态时间变化的过渡区。因此，HFpEF和HFmrEF，即射血分数未降低的心衰（HF-NEF），在心力衰竭的管理中都面临一些挑战。本文的目的是提供一篇全面的综述，包括HF-NEF的流行病学、病理生理学、临床表现和表型，并根据文献中的现有数据指导临床医生进行诊断和治疗。
