射血分数恢复与持续降低:从差异中探寻心力衰竭诊治新契机

Recovered and Persistent Reduced Ejection Fraction: Advance in Diagnosis and Treatment of Heart Failure from Two Different Types

随着心力衰竭新型治疗方法与规范化诊治的普及,患者心室逆重构与收缩功能改善愈发普遍,在临床上表现为左室射血分数(left ventricular ejection fraction,LVEF)的提升。这类射血分数恢复的心力衰竭(heart failure with recovered ejection fraction,HFrecEF)患者与持续性射血分数降低的心力衰竭(heart failure with persistent reduced ejection fraction,pHFrEF)患者在临床特征和预后情况等方面均存在明显差异,提示HFrecEF是一种全新的心力衰竭分型。但是目前对HFrecEF与pHFrEF的认识仍十分局限,尚缺乏明确定义以及管理与治疗的循证推荐。本文将对HFrecEF和pHFrEF的定义、病理生理机制、流行病学特征、管理与治疗、未来研究方向与临床意义等方面进行综述,并着重对比两类患者在临床特征及预后等方面的差异。

With the therapeutic method for heart failure progress,more patients experienced ventricular reverse remodeling and systolic function improvement,which was manifested as an increase in left ventricular ejection fraction(LVEF)in clinic.Notable differences presented in clinical characteristics and prognosis between patients with heart failure with recovered ejection fraction(HFrecEF)and patients with heart failure with persistent reduced ejection fraction(pHFrEF),which suggests that HFrecEF is an emerging type of heart failure.However,huge gaps remain in our current understanding of HFrecEF and pHFrEF,including lack of a clear definition and evidence-based recommendations for management and treatment.Accordingly,here we review the definition,pathophysiological mechanism,epidemiological characteristics,management and treatment,further research directions and clinical significance of HFrecEF and pHFrEF,and focus on the differences between these two groups in clinical characteristics and prognosis.