Fengler Karl, Kresoja Karl-Patrik, Rommel Karl-Philipp, Rosch Sebastian, Roeder Maximilian V, Desch Steffen, Thiele Holger, Lurz Philipp
Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
Struct Heart. 2022 Aug 2;6(4):100073. doi: 10.1016/j.shj.2022.100073. eCollection 2022 Aug.
Despite recent advances in the treatment of heart failure with preserved ejection fraction (HFpEF), the overall outcome is poor and evidence-based therapeutic options are scarce. So far, the only evidence-based therapy in HFpEF, sodium glucose linked transporter 2 inhibitors, has only insignificant effects in patients with a high EF (EF > 60%, HEF) when compared to a normal EF (EF 50%-60%, NEF). This could be explained by different biomechanical and cellular phenotypes of HFpEF across the range of EFs rather than a uniform pathophysiology. We aimed to investigate the concept of different phenotypes in the HEF and NEF using noninvasive single-beat estimations and to observe alterations in pressure-volume relations in both groups following sympathomodulation using renal denervation (RDN).
Patients from a previous study on RDN in HFpEF were stratified by having HFpEF with an HEF or NEF. Single-beat estimations were used to derive arterial elastance (Ea), end-systolic elastance (Ees), and diastolic capacitance (VPED).
Overall, 63 patients were classified as having an HEF, and 36 patients were classified as having an NEF. Ea did not differ between the groups and was reduced at follow-up in both groups ( < 0.01). Ees was higher and VPED was lower in the HEF than those in the NEF. Both were changed significantly at follow-up in the HEF but not in the NEF. Ees/Ea was lower in the NEF (0.95 ± 0.22 vs 1.15 ± 0.27, < 0.01) and was significantly increased in the NEF (by 0.08 ± 0.20, < 0.05) but not in the HEF.
Beneficial effects of RDN were observed in the NEF and HEF, supporting the further investigation of sympathomodulating treatments for HFpEF in future trials.
尽管射血分数保留的心力衰竭（HFpEF）治疗方面最近取得了进展，但总体预后较差，且缺乏循证治疗方案。到目前为止，HFpEF中唯一的循证治疗方法，即钠-葡萄糖协同转运蛋白2抑制剂，与正常射血分数（EF 50%-60%，NEF）的患者相比，对射血分数高（EF>60%，HEF）的患者效果甚微。这可以用HFpEF在不同射血分数范围内不同的生物力学和细胞表型来解释，而不是统一的病理生理学。我们旨在使用无创单次心搏估计来研究HEF和NEF中不同表型的概念，并观察两组在肾去神经支配（RDN）进行交感神经调节后压力-容积关系的变化。
先前一项关于HFpEF患者RDN研究中的患者，根据是否为HFpEF伴HEF或NEF进行分层。使用单次心搏估计来得出动脉弹性（Ea）、收缩末期弹性（Ees）和舒张期容量（VPED）。
总体而言，63例患者被归类为HEF，36例患者被归类为NEF。两组之间Ea无差异，且两组在随访时均降低（<0.01）。HEF组的Ees较高，VPED较低，与NEF组相比。两者在HEF组随访时均有显著变化，但NEF组无变化。NEF组的Ees/Ea较低（0.95±0.22对1.15±0.27，<0.01），且在NEF组显著升高（升高0.08±0.20，<0.05），但HEF组无变化。
在NEF和HEF组中均观察到RDN的有益效果，支持在未来试验中进一步研究HFpEF的交感神经调节治疗。
