射血分数保留型心力衰竭的研究进展

Research Progress of Heart Failure with Preserved Ejection Fraction

射血分数保留型心力衰竭(HFpEF)以休息或运动时左室充盈压升高,出现心力衰竭症状和体征为特征的一种临床综合征,其发病率随着年龄的增长而增长,且其患者多为老人,以及女性,特别是绝经期女性,更易出现左心室舒张功能不全,这可能与雌激素水平的降低有关。然而,目前HFpEF的病理生理学、病因和发病机制的研究进展推进缓慢,它的合并症也是尤为复杂,常见的合并症有高血压、肥胖和代谢障碍等,其发生的关键因素主要是炎症和一氧化氮(NO)水平失调。临床诊治方案亦是不够完善,诊断的标准是多方面且复杂的,目前有关的研究,例如血管紧张素受体脑啡肽酶抑制剂(ARNI),β-肾上腺素受体阻滞剂,磷酸二酯酶5(PDE-5)抑制剂,可溶性鸟苷酸环化酶(sGC)激动剂和钠-葡萄糖共转运蛋白-2抑制剂(SGLT-2i)等还未出现理想的结论。该文就目前诊疗研究进展进行梳理总结,以供参考。

Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by increased left ventricular filling pressure at rest or exercise,presenting with symptoms and signs of heart failure.Its morbidity increases with age,and its patients are mostly elderly and female.Postmenopausal women,in particular,are more likely to have left ventricular diastolic dysfunction,which may be associated with reduced estrogen levels.However,at present,the research on the pathophysiology,etiology and pathogenesis of HFpEF is progressing slowly,and its complications are particularly complex.Its common comorbidities include hypertension,obesity and metabolic disorders,and the key factors of its occurrence are inflammation and imbalance of nitric oxide(NO)levels.The clinical diagnosis and treatment plans are not perfect,its diagnostic criteria are multifaceted and complicated,the current related research,such as angiotensin receptor enkephalin enzyme inhibitors(ARNI),beta adrenergic receptor blockers,5 phosphodiesterase(PDE-5)inhibitor,soluble guanylate cyclase acid(sGC)agonists and sodium/glucose transporters-2 inhibitor(SGLT-2 i)are the ideal conclusion have not yet reached ideal conclusions.This paper summarized the current research progress of HFpEF in diagnosis and treatment for reference.