Jørgensen Troels Højsgaard, Søndergaard Lars
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Int J Heart Fail. 2022 Jan 19;4(1):12-23. doi: 10.36628/ijhf.2021.0038. eCollection 2022 Jan.
Patients with heart failure with preserved ejection fraction (HFpEF) constitutes a considerable sized population like that of subjects with heart failure with reduced ejection fraction. The symptoms include exercise induced dyspnoea and fatigue besides an increased mortality rate when compared to the general population. There is limited evidence of benefit from pharmacological therapy. A main pathophysiological mechanism is a left ventricular filling pressure that might be near to normal during resting conditions but increases during exercise leading to pulmonary congestion. Based on observations like the apparent lesser symptomatology in patients with combined mitral valve stenosis and atrial septal defect (Lutembacher syndrome) when compared to patients with isolated mitral valve stenosis, several Inter-Atrial Shunt Devices (IASD) have been developed with the intent to unload the pressure in the left atrium by creating a shunt into the right atrium. Smaller studies have found that the IASDs reduce the left ventricular filling pressure during exercise and increase the functional status of patients both subjectively and objectively with reported low rates of complications. These devices are undergoing further investigations and might prove to be a new paradigm in the treatment of patients with HFpEF.
射血分数保留的心力衰竭（HFpEF）患者构成了一个规模可观的群体，与射血分数降低的心力衰竭患者群体相当。其症状包括运动诱发的呼吸困难和疲劳，而且与普通人群相比死亡率更高。药物治疗的获益证据有限。一个主要的病理生理机制是左心室充盈压，其在静息状态下可能接近正常，但在运动时会升高，导致肺淤血。基于诸如二尖瓣狭窄合并房间隔缺损患者（鲁腾巴赫综合征）与单纯二尖瓣狭窄患者相比症状明显较轻等观察结果，已经研发了几种房间隔分流装置（IASD），旨在通过建立向右心房的分流来减轻左心房压力。较小规模的研究发现，IASD可降低运动时的左心室充盈压，并在主观和客观上提高患者的功能状态，且报道的并发症发生率较低。这些装置正在接受进一步研究，可能会成为治疗HFpEF患者的一种新范例。
