Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
Curr Heart Fail Rep. 2023 Oct;20(5):461-470. doi: 10.1007/s11897-023-00626-w. Epub 2023 Sep 2.
This review summarises key findings on treatment effects within phenotypical clusters of patients with heart failure (HF), making a distinction between patients with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).
Treatment response differed among clusters; ACE inhibitors were beneficial in all HFrEF phenotypes, while only some studies show similar beneficial prognostic effects in HFpEF patients. Beta-blockers had favourable effects in all HFrEF patients but not in HFpEF phenotypes and tended to worsen prognosis in older, cardiorenal patients. Mineralocorticoid receptor antagonists had more favourable prognostic effects in young, obese males and metabolic HFpEF patients. While a phenotype-guided approach is a promising solution for individualised treatment strategies, there are several aspects that still require improvements before such an approach could be implemented in clinical practice. Stronger evidence from clinical trials and real-world data may assist in establishing a phenotype-guided treatment approach for patient with HF in the future.
本综述总结了心力衰竭（HF）患者表型亚组内治疗效果的关键发现，区分了射血分数保留型心力衰竭（HFpEF）和射血分数降低型心力衰竭（HFrEF）患者。
各亚组间的治疗反应不同；血管紧张素转换酶抑制剂对所有 HFrEF 表型均有益，而仅有部分研究显示 HFpEF 患者存在类似的有益预后效果。β受体阻滞剂对所有 HFrEF 患者均有有利影响，但对 HFpEF 表型无效，且在老年、心肾患者中往往使预后恶化。盐皮质激素受体拮抗剂在年轻、肥胖男性和代谢性 HFpEF 患者中具有更有利的预后效果。虽然基于表型的治疗方法是个体化治疗策略的一种有前途的解决方案，但在该方法能够应用于临床实践之前，仍有几个方面需要改进。来自临床试验和真实世界数据的更有力证据可能有助于在未来为 HF 患者建立基于表型的治疗方法。
