Soltani Samira, Bauersachs Johann
Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Herz. 2025 Aug 25. doi: 10.1007/s00059-025-05327-9.
The treatment of heart failure with preserved ejection fraction (HFpEF) involves symptomatic management of congestion with diuretics (class I recommendation) and treatment with sodium-glucose linked transporter 2 (SGLT2) inhibitors for improvement of the prognosis, which have a class I recommendation across the entire spectrum of left ventricular ejection fraction (LVEF) in the current guidelines. The data supporting the recommendation of SGLT2 inhibitors in HFpEF come from the EMPEROR-Preserved and DELIVER studies. The FINEARTS-HF study showed positive effects on cardiovascular death/heart failure hospitalization of the treatment of HFpEF patients with finerenone, a nonsteroidal mineralocorticoid receptor antagonist. The STEP-HFpEF (2023) and SUMMIT (2024) studies investigated the treatment with glucagon-like peptide 1 (GLP-1) analogs in patients with HFpEF and obesity and showed positive outcomes regarding quality of life and, in the latter study, positive effects on heart failure events. The treatment of severe mitral and tricuspid valve regurgitation impacts not only the symptom burden but also hospitalization and overall prognosis in HFpEF patients.
射血分数保留的心力衰竭（HFpEF）的治疗包括使用利尿剂进行充血症状管理（I类推荐）以及使用钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂进行治疗以改善预后，在当前指南中，SGLT2抑制剂在整个左心室射血分数（LVEF）范围内均有I类推荐。支持在HFpEF中推荐使用SGLT2抑制剂的数据来自EMPEROR-Preserved和DELIVER研究。FINEARTS-HF研究显示，非甾体类盐皮质激素受体拮抗剂非奈利酮治疗HFpEF患者对心血管死亡/心力衰竭住院有积极影响。STEP-HFpEF（2023年）和SUMMIT（2024年）研究调查了胰高血糖素样肽1（GLP-1）类似物对HFpEF合并肥胖患者的治疗效果，结果显示对生活质量有积极影响，且在后者的研究中，对心力衰竭事件也有积极影响。重度二尖瓣和三尖瓣反流的治疗不仅影响HFpEF患者的症状负担，还影响其住院率和总体预后。
