射血分数中间值心力衰竭的研究进展

doi:10.12114/j.issn.1007-9572.2021.00.005

中国全科医学 ›› 2021, Vol. 24 ›› Issue (5): 526-532.DOI: 10.12114/j.issn.1007-9572.2021.00.005

所属专题：心力衰竭最新文章合辑；心血管最新文章合辑

射血分数中间值心力衰竭的研究进展

石芳娥，朱继红*

100044 北京市，北京大学人民医院急诊科
*通信作者：朱继红，教授，主任医师；E-mail：zhujihong64@sina.com

出版日期:2021-02-15 发布日期:2021-02-15
基金资助:
基金项目：北京市科技计划项目（Z161100000516045）

Novel Advances in Heart Failure with Mid-range Ejection Fraction　

SHI Fang'e，ZHU Jihong*

Department of Emergency Medicine，Peking University People's Hospital，Beijing 100044，China
*Corresponding author：ZHU Jihong，Professor，Chief physician；E-mail：zhujihong64@sina.com

Published:2021-02-15 Online:2021-02-15

摘要/Abstract

摘要： 心力衰竭是心脏疾病发展的终末阶段。既往研究根据左心室射血分数将心力衰竭分为两种类型：射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）。而2016年欧洲心脏病学会（ESC）心力衰竭指南根据左心室射血分数将心力衰竭分为HFrEF、射血分数中间值心力衰竭（HFmrEF）及HFpEF。本文通过对HFrEF、HFmrEF及HFpEF的流行病学、临床特征、病理生理学、预后及治疗等方面进行总结分析，发现HFmrEF可能是HFrEF及HFpEF的中间和过渡型。目前在HFmrEF诊疗策略的多个方面仍有待进一步验证，比如更积极地抗心肌缺血治疗及射血分数动态监测对心肌细胞的保护价值；心血管和非心血管疾病合并症的筛查协助认识HFmrEF病理生理特征的临床价值；心脏磁共振成像检查对 HFmrEF 病理生理学改变的诊断价值；C端成纤维细胞生长因子23（cFGF23）和冠状窦神经肽Y（NPY）水平在HFmrEF中的风险预测和临床转归上的作用价值。更深入地探索与研究会进一步提高临床医生对HFmrEF发病机制与临床特征的理解，利于制定更有效的诊疗策略。

关键词: 心力衰竭, 射血分数中间值心力衰竭, 临床特征, 综述

Abstract: Heart failure is the final stage of the development of heart disease.Previous studies classified heart failure into two types based on left ventricular ejection fraction：heart failure with preserved ejection fraction（HFpEF）and heart failure with reduced ejection fraction（HFrEF）.But according to the 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure，heart failure is categorized into HFpEF，HFrEF and heart failure with mid-range ejection fraction（HFmrEF）based on the LVEF.The comparison of epidemiology，clinical characteristics，pathophysiology，treatment and prognosis among the patients with HFrEF，HFmrEF and HFpEF suggests that HFmrEF may be an intermediate phenotype between HFrEF and HFpEF.There are still many diagnosis and treatment strategies for HFmrEF that need to be further explored，such as finding active anti-myocardial ischemia therapies and examining the protective value of ambulatory monitoring of ejection fraction for cardiomyocytes，clinical value of screening for cardiovascular and non-cardiovascular comorbidities in understanding the pathophysiological characteristics of HFmrEF，the diagnostic value of cardiac MRI for pathophysiological changes of HFmrEF，and values of cFGF23 and NPY levels in risk and clinical outcome prediction of HFmrEF.The exploration and research of more relevant information will contribute to improving clinicians' understanding of the pathogenesis and characteristics of HFmrEF to develop effective diagnosis and treatment strategies.

Key words: Heart failure, Heart failure with mid-range ejection fraction, Clinical characteristics, Review

石芳娥,朱继红. 射血分数中间值心力衰竭的研究进展[J]. 中国全科医学, 2021, 24(5): 526-532. DOI: 10.12114/j.issn.1007-9572.2021.00.005.
SHI Fang'e,ZHU Jihong. Novel Advances in Heart Failure with Mid-range Ejection Fraction　[J]. Chinese General Practice, 2021, 24(5): 526-532. DOI: 10.12114/j.issn.1007-9572.2021.00.005.

参考文献

［1］LüSCHER T F.Heart failure:the cardiovascular epidemic of the 21st century［J］．Eur Heart J，2015，36（7）:395-397．DOI：10.1093/eurheartj/ehv004.
［2］Correction to：Heart Disease and Stroke Statistics-2017 Update：a Report From the American Heart Association［J］．Circulation，2017，135（10）：e646．DOI：10.1161/CIR.0000000000000491.
［3］AMBROSY A P，FONAROW G C，BUTLER J，et al．The global health and economic burden of hospitalizations for heart failure：lessons learned from hospitalized heart failure registries［J］．J Am Coll Cardiol，2014，63（12）：1123-1133．DOI：10.1016/j.jacc.2013.11.053.
［4］SHIMOKAWA H，MIURA M，NOCHIOKA K，et al．Heart failure as a general pandemic in Asia［J］．Eur J Heart Fail，2015，17（9）：884-892．DOI：10.1002/ejhf.319.
［5］VOS T，FLAXMAN A D，NAGHAVI M，et al．Years lived with disability（YLDs）for 1160 sequelae of 289 diseases and injuries 1990-2010：a systematic analysis for the Global Burden of Disease Study 2010［J］．Lancet，2012，380（9859）：2163-2196．DOI：10.1016/S0140-6736（12）61729-2.
［6］KENNEDY J W，BAXLEY W A，FIGLEY M M，et al．Quantitative angiocardiography.I.The normal left ventricle in man［J］．Circulation，1966，34（2）：272-278．DOI：10.1161/01.cir.34.2.272.
［7］HUNT S A，ABRAHAM W T，CHIN M H，et al．ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult：a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines（Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure）：developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation：endorsed by the Heart Rhythm Society［J］．Circulation，2005，112（12）：e154-235．DOI：10.1161/CIRCULATIONAHA.105.167586.
［8］射血分数正常心力衰竭诊治的中国专家共识［J］．中国医刊，2010，45（11）：63-67．DOI：10.3969/j.issn.1008-1070.2010.11.027.
［9］MCMURRAY J J，ADAMOPOULOS S，ANKER S D，et al．ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012：the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology.Developed in collaboration with the Heart Failure Association（HFA）of the ESC［J］．Eur J Heart Fail，2012，14（8）：803-869．DOI：10.1093/eurjhf/hfs105.
［10］YANCY C W，JESSUP M，BOZKURT B，et al．2013 ACCF/AHA guideline for the management of heart failure：a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines［J］．J Am Coll Cardiol，2013，62（16）：e147-239．DOI：10.1016/j.jacc.2013.05.019.
［11］LAM C S P，SOLOMON S D.The middle child in heart failure：heart failure with mid-range ejection fraction（40%-50%）［J］．Eur J Heart Fail，2014，16（10）：1049-1055．DOI：10.1002/ejhf.159.
［12］PONIKOWSKI P，VOORS A A，ANKER S D，et al．2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure：the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology（ESC）.Developed with the special contribution of the Heart Failure Association（HFA）of the ESC［J］．Eur J Heart Fail，2016，18（8）：891-975．DOI：10.1002/ejhf.592.
［13］中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018［J］．中华心血管病杂志，2018，46（10）：760-789．DOI：10.3760/cma.j.issn.2096-3076.2018.12.002.
［14］BENJAMIN E J，BLAHA M J，CHIUVE S E，et al．Heart Disease and Stroke Statistics-2017 Update：a Report From the American Heart Association［J］．Circulation，2017，135（10）：e146-603．DOI：10.1161/CIR.0000000000000485.
［15］HEIDENREICH P A，ALBERT N M，ALLEN L A，et al．Forecasting the impact of heart failure in the United States：a policy statement from the American Heart Association［J］．Circ Heart Fail，2013，6（3）：606-619．DOI：10.1161/HHF.0b013e318291329a.
［16］COLES A H，TISMINETZKY M，YARZEBSKI J，et al．Magnitude of and Prognostic Factors Associated With 1-Year Mortality After Hospital Discharge for Acute Decompensated Heart Failure Based on Ejection Fraction Findings［J］．J Am Heart Assoc，2015，4（12）：e002303．DOI：10.1161/JAHA.115.002303.
［17］KOH A S，TAY W T，TENG T H K，et al．A comprehensive population-based characterization of heart failure with mid-range ejection fraction［J］．Eur J Heart Fail，2017，19（12）：1624-1634．DOI：10.1002/ejhf.945.
［18］RICKENBACHER P，KAUFMANN B A，MAEDER M T，et al．Heart failure with mid-range ejection fraction：a distinct clinical entity? Insights from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure（TIME-CHF）［J］．Eur J Heart Fail，2017，19（12）：1586-1596．DOI：10.1002/ejhf.798.
［19］LUND L H，CLAGGETT B，LIU J，et al．Heart failure with mid-range ejection fraction in CHARM：characteristics，outcomes and effect of candesartan across the entire ejection fraction spectrum［J］．Eur J Heart Fail，2018，20（8）：1230-1239．DOI：10.1002/ejhf.1149.
［20］王华，李莹莹，柴坷，等．中国住院心力衰竭患者流行病学及治疗现状［J］．中华心血管病杂志，2019，47（11）：865-874．DOI：10.3760/cma.j.issn.0253-3758.2019.11.004.
WANG H，LI Y Y，CHAI K，et al．Contemporary epidemiology and treatment of hospitalized heart failure patients in real clinical practice in China［J］．Chinese Journal of Cardiology，2019，47（11）：865-874．DOI：10.3760/cma.j.issn.0253-3758.2019.11.004.
［21］SHAH K S，XU H L，MATSOUAKA R A，et al．Heart failure with preserved，borderline，and reduced ejection fraction：5-year outcomes［J］．J Am Coll Cardiol，2017，70（20）：2476-2486．DOI：10.1016/j.jacc.2017.08.074.
［22］CHIONCEL O，LAINSCAK M，SEFEROVIC P M，et al．Epidemiology and one-year outcomes in patients with chronic heart failure and preserved，mid-range and reduced ejection fraction：an analysis of the ESC Heart Failure Long-Term Registry［J］．Eur J Heart Fail，2017，19（12）：1574-1585．DOI：10.1002/ejhf.813.
［23］STRENG K W，NAUTA J F，HILLEGE H L，et al．Non-cardiac comorbidities in heart failure with reduced，mid-range and preserved ejection fraction［J］．Int J Cardiol，2018，271：132-139．DOI：10.1016/j.ijcard.2018.04.001.
［24］BRUCKS S，LITTLE W C，CHAO T，et al．Contribution of left ventricular diastolic dysfunction to heart failure regardless of ejection fraction［J］．Am J Cardiol，2005，95（5）：603-606．DOI：10.1016/j.amjcard.2004.11.006.
［25］YU C M，LIN H，YANG H，et al．Progression of systolic abnormalities in patients with “isolated” diastolic heart failure and diastolic dysfunction［J］．Circulation，2002，105（10）：1195-1201．DOI：10.1161/hc1002.105185.
［26］DOEBLIN P，HASHEMI D，TANACLI R，et al．CMR Tissue Characterization in Patients with HFmrEF［J］．J Clin Med，2019，8（11）：E1877．DOI：10.3390/jcm8111877.
［27］中国医疗保健国际交流促进会循证医学分会，海峡两岸医药卫生交流协会老年医学专业委员会.心力衰竭生物标志物中国专家共识［J］．中华检验医学杂志，2020，43（2）：130-141．DOI：10.3760/cma.j.issn.1009-9158.2020.02.007.
［28］TROMP J，KHAN M A F，MENTZ R J，et al．Biomarker Profiles of Acute Heart Failure Patients With a Mid-Range Ejection Fraction［J］．JACC Heart Fail，2017，5（7）：507-517．DOI：10.1016/j.jchf.2017.04.007.
［29］AJIJOLA O A，CHATTERJEE N A，GONZALES M J，et al．Coronary sinus neuropeptide Y levels and adverse outcomes in patients with stable chronic heart failure［J］．JAMA Cardiol，2020，5（3）：318-325．DOI：10.1001/jamacardio.2019.4717.
［30］TER MAATEN J M，VOORS A A，DAMMAN K，et al．Fibroblast growth factor 23 is related to profiles indicating volume overload，poor therapy optimization and prognosis in patients with new-onset and worsening heart failure［J］．Int J Cardiol，2018，253：84-90．DOI：10.1016/j.ijcard.2017.10.010.
［31］GRUSON D，FERRACIN B，AHN S A，et al．Head to head comparison of intact and C-terminal fibroblast growth factor 23 in heart failure patients with reduced ejection fraction［J］．Int J Cardiol，2017，248：270-273．DOI：10.1016/j.ijcard.2017.06.129.
［32］WOHLFAHRT P，MELENOVSKY V，KOTRC M，et al．Association of fibroblast growth factor-23 levels and angiotensin-converting enzyme inhibition in chronic systolic heart failure［J］．JACC Heart Fail，2015，3（10）：829-839．DOI：10.1016/j.jchf.2015.05.012.
［33］LEAF D E，SIEW E D，EISENGA M F，et al．Fibroblast growth factor 23 associates with death in critically ill patients［J］．Clin J Am Soc Nephrol，2018，13（4）：531-541．DOI：10.2215/CJN.10810917.
［34］ST?HR R，BRANDENBURG V M，HEINE G H，et al．Limited role for fibroblast growth factor 23 in assessing prognosis in heart failure patients：data from the TIME-CHF trial［J］．Eur J Heart Fail，2020，22（4）：701-709．DOI：10.1002/ejhf.1749.
［35］SAVARESE G，HAGE C，ORSINI N，et al．Reductions in N-terminal pro-brain natriuretic peptide levels are associated with lower mortality and heart failure hospitalization rates in patients with heart failure with mid-range and preserved ejection fraction［J］．Circ Heart Fail，2016，9（11）：e003105．DOI：10.1161/CIRCHEARTFAILURE.116.003105.
［36］BHAMBHANI V，KIZER J R，LIMA J A C，et al．Predictors and outcomes of heart failure with mid-range ejection fraction［J］．Eur J Heart Fail，2018，20（4）：651-659．DOI：10.1002/ejhf.1091.
［37］AHMAD T，FIUZAT M，NEELY B，et al．Biomarkers of myocardial stress and fibrosis as predictors of mode of death in patients with chronic heart failure［J］．JACC Heart Fail，2014，2（3）：260-268．DOI：10.1016/j.jchf.2013.12.004.
［38］BAYES-GENIS A，DE ANTONIO M，VILA J，et al．Head-to-head comparison of 2 myocardial fibrosis biomarkers for long-term heart failure risk stratification：ST2 versus galectin-3［J］．J Am Coll Cardiol，2014，63（2）：158-166．DOI：10.1016/j.jacc.2013.07.087.
［39］VEDIN O，LAM C S P，KOH A S，et al．Significance of ischemic heart disease in patients with heart failure and preserved，midrange，and reduced ejection fraction：a nationwide cohort study［J］．2017，10（6）：e003875．DOI：10.1161/CIRCHEARTFAILURE.117.003875.
［40］TSUJI K，SAKATA Y，NOCHIOKA K，et al．Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study［J］．Eur J Heart Fail，2017，19（10）：1258-1269．DOI：10.1002/ejhf.807.
［41］RASTOGI A，NOVAK E，PLATTS A E，et al．Epidemiology，pathophysiology and clinical outcomes for heart failure patients with a mid-range ejection fraction［J］．Eur J Heart Fail，2017，19（12）：1597-1605．DOI：10.1002/ejhf.879.
［42］SEFEROVIC P M，PONIKOWSKI P，ANKER S D，et al．Clinical practice update on heart failure 2019：pharmacotherapy，procedures，devices and patient management.An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology［J］．Eur J Heart Fail，2019，21（10）：1169-1186．DOI：10.1002/ejhf.1531.
［43］CLELAND J G F，BUNTING K V，FLATHER M D，et al．Beta-blockers for heart failure with reduced，mid-range，and preserved ejection fraction：an individual patient-level analysis of double-blind randomized trials［J］．Eur Heart J，2018，39（1）：26-35．DOI：10.1093/eurheartj/ehx564.
［44］SOLOMON S D，CLAGGETT B，LEWIS E F，et al．Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction［J］．Eur Heart J，2016，37（5）：455-462．DOI：10.1093/eurheartj/ehv464.
［45］PERKOVIC V，JARDINE M J，NEAL B，et al．Canagliflozin and renal outcomes in type 2 diabetes and nephropathy［J］．N Engl J Med，2019，380（24）：2295-2306．DOI：10.1056/NEJMoa1811744.
［46］MCMURRAY J J V，SOLOMON S D，INZUCCHI S E，et al．Dapagliflozin in patients with heart failure and reduced ejection fraction［J］．N Engl J Med，2019，381（21）：1995-2008．DOI：10.1056/NEJMoa1911303.
［47］ANKER S D，BUTLER J，FILIPPATOS G S，et al．Evaluation of the effects of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality in patients with chronic heart failure and a preserved ejection fraction：rationale for and design of the EMPEROR-Preserved Trial［J］．Eur J Heart Fail，2019，21（10）：1279-1287．DOI：10.1002/ejhf.1596.

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射血分数中间值心力衰竭的研究进展

Novel Advances in Heart Failure with Mid-range Ejection Fraction

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