Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, 53100 Siena, Italy.
San Giovanni di Dio Hospital, 50143 Florence, Italy.
Biomolecules. 2023 Jan 13;13(1):173. doi: 10.3390/biom13010173.
Heart failure with preserved ejection fraction (HFpEF) remains a poorly characterized syndrome with many unknown aspects related to different patient profiles, various associated risk factors and a wide range of aetiologies. It comprises several pathophysiological pathways, such as endothelial dysfunction, myocardial fibrosis, extracellular matrix deposition and intense inflammatory system activation. Until now, HFpEF has only been described with regard to clinical features and its most commonly associated risk factors, disregarding all biological mechanisms responsible for cardiovascular deteriorations. Recently, innovations in laboratory and metabolomic findings have shown that HFpEF appears to be strictly related to specific cells and molecular mechanisms' dysregulation. Indeed, some biomarkers are efficient in early identification of these processes, adding new insights into diagnosis and risk stratification. Moreover, recent advances in intermediate metabolites provide relevant information on intrinsic cellular and energetic substrate alterations. Therefore, a systematic combination of clinical imaging and laboratory findings may lead to a 'precision medicine' approach providing prognostic and therapeutic advantages. The current review reports traditional and emerging biomarkers in HFpEF and it purposes a new diagnostic approach based on integrative information achieved from risk factor burden, hemodynamic dysfunction and biomarkers' signature partnership.
射血分数保留的心力衰竭（HFpEF）仍然是一种特征不明确的综合征，与不同患者特征、各种相关危险因素和广泛的病因有关的许多未知方面。它包括几种病理生理途径，如内皮功能障碍、心肌纤维化、细胞外基质沉积和强烈的炎症系统激活。到目前为止，HFpEF 仅根据临床特征及其最常见的相关危险因素进行描述，而忽略了导致心血管恶化的所有生物学机制。最近，实验室和代谢组学发现的创新表明，HFpEF 似乎与特定细胞和分子机制的失调密切相关。事实上，一些生物标志物在这些过程的早期识别中很有效，为诊断和风险分层提供了新的见解。此外，中间代谢物的最新进展提供了关于内在细胞和能量底物改变的相关信息。因此，临床影像学和实验室发现的系统组合可能会导致一种“精准医学”方法，提供预后和治疗优势。本综述报告了 HFpEF 中的传统和新兴生物标志物，并基于从危险因素负担、血流动力学功能障碍和生物标志物特征相关性中获得的综合信息，提出了一种新的诊断方法。
