Department of Cardiology, Affiliated Hospital of Putian University, School of Clinical Medicine, Fujian Medical University, Putian, China.
ESC Heart Fail. 2024 Feb;11(1):13-27. doi: 10.1002/ehf2.14562. Epub 2023 Nov 20.
Heart failure with preserved ejection fraction (HFpEF) is a group of clinical syndromes that exhibit a remarkably heterogeneous phenotype, characterized by symptoms and signs of heart failure, left ventricular diastolic dysfunction, elevated levels of natriuretic peptides, and an ejection fraction greater than or equal to 50%. With the aging of the population and the escalating prevalence of hypertension, obesity, and diabetes, the incidence of HFpEF is progressively rising. Drug therapy options for HFpEF are currently limited, and the associated high risk of cardiovascular mortality and heart failure rehospitalization significantly impact patients' quality of life and longevity while imposing a substantial economic burden on society. Recent research indicates that certain device-based therapies may serve as valuable adjuncts to drug therapy in patients with specific phenotypes of HFpEF, effectively improving symptoms and quality of life while reducing the risk of readmission for heart failure. These include inter-atrial shunt and greater splanchnic nerve ablation to reduce left ventricular filling pressure, implantable heart failure monitor to guide diuresis, left atrial pacing to correct interatrial dyssynchrony, cardiac contractility modulation to enhance cardiac calcium handling, as well as renal denervation, baroreflex activation therapy, and vagus nerve stimulation to restore the autonomic imbalance. In this review, we provide a comprehensive overview of the mechanisms and clinical evidence pertaining to these devices, with the aim of enhancing therapeutic strategies for HFpEF.
射血分数保留的心力衰竭（HFpEF）是一组具有显著异质性表型的临床综合征，其特征为心力衰竭症状和体征、左心室舒张功能障碍、利钠肽水平升高以及射血分数大于或等于 50%。随着人口老龄化以及高血压、肥胖和糖尿病的患病率不断上升，HFpEF 的发病率也在逐渐上升。HFpEF 的药物治疗选择目前有限，而心血管死亡率和心力衰竭再住院率高的相关风险显著影响患者的生活质量和寿命，同时给社会带来巨大的经济负担。最近的研究表明，某些基于设备的治疗方法可能是 HFpEF 特定表型患者药物治疗的有价值的辅助手段，有效改善症状和生活质量，同时降低心力衰竭再入院的风险。这些方法包括房间隔分流术和更大的内脏神经消融术以降低左心室充盈压、植入式心力衰竭监测仪以指导利尿、左心房起搏以纠正房间隔不同步、心脏收缩力调节以增强心脏钙处理以及肾脏去神经支配、压力感受器激活治疗和迷走神经刺激以恢复自主神经失衡。在这篇综述中，我们全面概述了这些设备的机制和临床证据，旨在增强 HFpEF 的治疗策略。
