Bauer Maria, Gadkari Mahin, Martinez Yus Marta, Santhanam Lakshmi, Steppan Jochen
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Department of Chemical and Biomolecular Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, United States.
J Appl Physiol (1985). 2025 Jun 1;138(6):1449-1473. doi: 10.1152/japplphysiol.00595.2024. Epub 2025 May 5.
Heart failure is a complex clinical syndrome that continues to be a leading cause of cardiovascular morbidity and mortality around the world. Despite major advances in its treatment and management, the rate of hospitalization and mortality has remained unchanged in the past decade. Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of all incident-based hospital admissions for decompensated heart failure and represents a global healthcare problem. Moreover, its incidence rate among all heart failures is increasing, and survival rates are significantly <50% at 5 years. Importantly, HFpEF disproportionately affects women after menopause, with female sex being independently associated with the prevalence of HFpEF and worse outcomes. The pathophysiology and critical molecular mechanisms underlying the progression of the abnormalities of this multifaceted syndrome are incompletely understood, and no evidence-based and target-directed treatment is available to prevent or cure its structural and functional myocardial dysfunction. To overcome this knowledge gap and develop targeted HFpEF therapies, animal models remain at the forefront of cutting-edge research studies. However, this is complicated by the lack of suitable animal models available that recapitulate the HFpEF phenotype in both sexes. This narrative review provides an overview of clinical features of the disease in both sexes and details carefully selected animal models with a particular focus on their ability to replicate sex-based differences.
心力衰竭是一种复杂的临床综合征,仍然是全球心血管疾病发病率和死亡率的主要原因。尽管在其治疗和管理方面取得了重大进展,但在过去十年中,住院率和死亡率仍未改变。射血分数保留的心力衰竭(HFpEF)占失代偿性心力衰竭所有基于事件的住院病例的一半以上,是一个全球性的医疗问题。此外,其在所有心力衰竭中的发病率正在上升,5年生存率显著低于50%。重要的是,HFpEF对绝经后女性的影响尤为严重,女性性别与HFpEF的患病率及更差的预后独立相关。这种多方面综合征异常进展背后的病理生理学和关键分子机制尚未完全明确,目前尚无基于证据的靶向治疗方法来预防或治愈其结构和功能性心肌功能障碍。为了填补这一知识空白并开发针对HFpEF的疗法,动物模型仍然是前沿研究的重点。然而,由于缺乏能够在两性中重现HFpEF表型的合适动物模型,这一过程变得复杂。本叙述性综述概述了该疾病在两性中的临床特征,并详细介绍了精心挑选的动物模型,特别关注它们复制基于性别的差异的能力。
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