Jyotsna Fnu, Mahfooz Kamran, Sohail Haris, Kumar Sumeet, Adeeb Maham, Anand Dev, Kumar Rahul, Rekha Fnu, Varrassi Giustino, Khatri Mahima, Kumar Satesh
Medicine, Dr. Bhim Rao Ambedkar Medical College and Hospital, Sahibzada Ajit Singh Nagar, IND.
Internal Medicine, Lincoln Medical Center, New York City, USA.
Cureus. 2023 Aug 10;15(8):e43279. doi: 10.7759/cureus.43279. eCollection 2023 Aug.
Impairment in ventricular relaxation and preserved left ventricular ejection fraction are the two main features of heart failure with preserved ejection fraction (HFpEF) a difficult clinical condition. Therapeutic choices for HFpEF patients are still scarce despite its rising frequency and negative effects on morbidity and mortality, necessitating creative methods to enhance results. The increased thromboembolic risk seen in these individuals raises questions about the relevance of anticoagulation in the therapy of HFpEF. Although anticoagulation has been shown to be beneficial in heart failure with decreased ejection fraction (HFrEF) and other high-risk cardiovascular disorders, its efficacy and safety in HFpEF present a challenging therapeutic challenge. Anticoagulants have been the subject of clinical trials in HFpEF, but the results have been conflicting, giving clinicians only a little information with which to make decisions. The decision-making process is made more difficult by worries about potential bleeding hazards, particularly in susceptible elderly HFpEF patients with other comorbidities. The link between heart failure and anticoagulant medication in HFpEF is thoroughly analyzed in this narrative review. In HFpEF, cardiac fibrosis and endothelial dysfunction create a prothrombotic milieu, as is highlighted in this passage. Also covered are recent developments in innovative biomarker research and cutting-edge imaging techniques, which may provide ways to spot HFpEF patients who might benefit from anticoagulation. This therapeutic conundrum may be resolved by using precision medicine strategies based on risk classification and individualized therapy choices. This review emphasizes the need for more research to establish the best use of anticoagulation in HFpEF within the framework of personalized therapy and shared decision-making. To successfully manage thromboembolic risk and reduce bleeding consequences in HFpEF patients, it is essential to perform well-designed clinical studies and advance our understanding of the pathophysiology of HFpEF. These developments may ultimately improve the prognosis and quality of life for people who suffer from this difficult and mysterious ailment.
心室舒张功能受损和左心室射血分数保留是射血分数保留的心力衰竭（HFpEF）的两个主要特征，这是一种临床难题。尽管HFpEF的发病率不断上升且对发病率和死亡率有负面影响，但针对HFpEF患者的治疗选择仍然很少，因此需要创新方法来改善治疗效果。这些患者中血栓栓塞风险增加，引发了关于抗凝治疗在HFpEF治疗中的相关性的疑问。尽管抗凝治疗已被证明对射血分数降低的心力衰竭（HFrEF）和其他高危心血管疾病有益，但其在HFpEF中的疗效和安全性带来了具有挑战性的治疗难题。抗凝剂一直是HFpEF临床试验的主题，但结果相互矛盾，给临床医生提供的决策信息很少。对潜在出血风险的担忧使决策过程更加困难，尤其是在患有其他合并症的易感老年HFpEF患者中。本叙述性综述全面分析了HFpEF中心力衰竭与抗凝药物之间的联系。如本文所述，在HFpEF中，心脏纤维化和内皮功能障碍会形成促血栓形成环境。还介绍了创新生物标志物研究和前沿成像技术的最新进展，这些进展可能为识别可能从抗凝治疗中获益的HFpEF患者提供方法。通过基于风险分类和个性化治疗选择的精准医学策略，可能解决这一治疗难题。本综述强调需要进行更多研究，以在个性化治疗和共同决策的框架内确定抗凝治疗在HFpEF中的最佳应用。为了成功管理HFpEF患者的血栓栓塞风险并减少出血后果，开展精心设计的临床研究并加深我们对HFpEF病理生理学的理解至关重要。这些进展最终可能改善患有这种困难且神秘疾病的患者的预后和生活质量。
