Coppi Francesca, Pagnoni Gianluca, Grossule Francesca, Nassar Ashraf, Maini Arianna, Masaracchia Giuseppe, Sbarra Francesco, Battigaglia Elisa, Maggio Enrico, Aschieri Daniela, Moscucci Federica, Pinti Marcello, Mattioli Anna Vittoria, Fedele Francesco, Sciomer Susanna
Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy.
National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy.
J Cardiovasc Dev Dis. 2025 Jun 5;12(6):213. doi: 10.3390/jcdd12060213.
Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of heart failure cases and is primarily characterized by impaired diastolic function, leading to increased ventricular filling pressures and symptoms like dyspnea and reduced exercise tolerance. Significant gender-specific differences are observed, with women, particularly post-menopausal, experiencing higher prevalence and distinct clinical profiles compared to men. Diastolic dysfunction in HFpEF involves altered cellular mechanisms such as reduced SERCA2a expression, impacting calcium handling and myocardial relaxation. Diagnostic strategies mainly employ echocardiography, including Doppler imaging, tissue Doppler imaging, and strain imaging, to assess ventricular relaxation and stiffness. However, early identification remains challenging, necessitating advanced tools like cardiac magnetic resonance and exercise stress testing for accurate diagnosis, especially in women who often present with subtle symptoms. Treatment options for HFpEF have traditionally been limited, but recent trials, notably EMPEROR-PRESERVED and DELIVER, demonstrated significant cardiovascular benefits using sodium-glucose cotransporter-2 (SGLT2) inhibitors. Additionally, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown promising results, particularly in obese patients. Despite these advances, gender differences in therapeutic response necessitate further research for personalized management strategies. Understanding sex-specific pathophysiological mechanisms and optimizing diagnostic criteria remain essential to improving prognosis and quality of life in HFpEF patients.
射血分数保留的心力衰竭（HFpEF）约占心力衰竭病例的50%，其主要特征是舒张功能受损，导致心室充盈压升高以及出现呼吸困难和运动耐量降低等症状。观察到显著的性别差异，女性，尤其是绝经后女性，与男性相比患病率更高且临床特征不同。HFpEF中的舒张功能障碍涉及细胞机制改变，如肌浆网钙ATP酶2a（SERCA2a）表达降低，影响钙处理和心肌舒张。诊断策略主要采用超声心动图，包括多普勒成像、组织多普勒成像和应变成像，以评估心室舒张和僵硬度。然而，早期识别仍然具有挑战性，需要心脏磁共振和运动负荷试验等先进工具进行准确诊断，尤其是对于经常表现出细微症状的女性。传统上，HFpEF的治疗选择有限，但最近的试验，尤其是EMPEROR-PRESERVED和DELIVER试验，表明使用钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂可带来显著的心血管益处。此外，胰高血糖素样肽-1受体激动剂（GLP-1 RAs）已显示出有前景的结果，尤其是在肥胖患者中。尽管有这些进展，但治疗反应中的性别差异需要进一步研究以制定个性化管理策略。了解性别特异性病理生理机制并优化诊断标准对于改善HFpEF患者的预后和生活质量仍然至关重要。
