Kodur Nandan, Tang W H Wilson
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, US.
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, US.
Curr Treat Options Cardiovasc Med. 2024 Jun;26(6):139-160. doi: 10.1007/s11936-024-01038-2. Epub 2024 May 20.
The purpose of this review is to discuss myocardial recovery in heart failure with reduced ejection fraction (HFrEF) and to summarize the contemporary insights regarding heart failure with improved ejection fraction (HFimpEF).
Improvement in left ventricular ejection fraction (LVEF ≥ 40%) with improved prognosis can be achieved in one out of three (10-40%) patients with HFrEF treated with guideline-directed medical therapy. Clinical predictors include non-ischemic etiology of HFrEF, less abnormal blood or imaging biomarkers, and lack of specific pathogenic genetic variants. However, a subset of patients may ultimately relapse, suggesting that many patients are merely in remission rather than having fully recovered.
Patients with HFimpEF have improved prognosis but nonetheless remain at risk of relapse and long-term adverse events. Future studies will hopefully chart the natural history of HFimpEF and identify clinical predictors such as blood or novel imaging biomarkers that distinguish subgroups of patients based on differential trajectory and prognosis.
本综述旨在探讨射血分数降低的心力衰竭（HFrEF）患者的心肌恢复情况，并总结关于射血分数改善的心力衰竭（HFimpEF）的当代见解。
接受指南指导药物治疗的HFrEF患者中，三分之一（10%-40%）的患者可实现左心室射血分数（LVEF≥40%）改善且预后改善。临床预测因素包括HFrEF的非缺血性病因、血液或影像学生物标志物异常程度较低以及缺乏特定致病基因变异。然而，一部分患者最终可能复发，这表明许多患者只是处于缓解状态而非完全康复。
HFimpEF患者预后有所改善，但仍有复发和长期不良事件风险。未来研究有望明确HFimpEF的自然病程，并识别出如血液或新型影像学生物标志物等临床预测因素，这些因素可根据不同病程轨迹和预后区分患者亚组。
