射血分数超常的心力衰竭的研究进展

doi:10.12114/j.issn.1007-9572.2024.0307

摘要/Abstract

摘要： 目前越来越多的研究证明射血分数超常的心力衰竭（HFsnEF）是一种新的心力衰竭表型，具有不同的特点，目前国内外对其研究仍处于探索阶段。目前对于超常射血分数（snLVEF）的临界值存有争议，但多数研究将其定义为左心室射血分数>65%；HFsnEF患者老年人、女性的比例更高，脑钠肽值更低，左心室更小，瓣膜疾病、心律失常和高血压性心脏病是主要的心力衰竭病因；HFsnEF和死亡率之间的关系具有性别依赖性，可能由于老年女性好发冠状动脉微血管障碍，加之心脏体积小、交感神经兴奋性高，使其更有可能发生心血管事件。目前对于HFsnEF的诊断和治疗仍沿用射血分数保留的心力衰竭的方法。本文通过梳理文献，系统地探讨了HFsnEF的研究进展，以期为HFsnEF的深入研究提供借鉴。

关键词: 心力衰竭, 射血分数超常的心力衰竭, 射血分数, 交感神经, 综述

Abstract:

More and more studies have proved that heart failure with supra-normal ejection fraction (HFsnEF) is a new heart failure phenotype with different characteristics, but its study is still in the exploratory stage at home and abroad. The critical value of supernormal ejection fraction (snLVEF) is still controversial, but most studies define it as left ventricular ejection fraction>65%; the proportion of elderly and female patients with HFsnEF is higher, with lower natriuretic peptide values and smaller left ventricles, and valvular disease, arrhythmia, and hypertensive heart disease are the main causes of heart failure; and the relationship between HFsnEF and mortality has a gender-dependent nature, possibly due to the prevalence of coronary microvascular disorders in elderly women, coupled with small heart size and high sympathetic excitability, making them more likely to suffer cardiovascular events; the current diagnosis and treatment of HFsnEF still follows the HFpEF approach. By combing the literature, this paper systematically discusses the research progress of HFsnEF, with a view to providing a reference for the in-depth study of HFsnEF.

Key words: Heart failure, Heart failure with supra-normal ejection fraction, Ejection fraction, Sympathetic nervous system, Review

董浩铖,郝潇,安东,等. 射血分数超常的心力衰竭的研究进展[J]. 中国全科医学, 2025, 28(21): 2692-2696. DOI: 10.12114/j.issn.1007-9572.2024.0307.
DONG Haocheng,HAO Xiao,AN Dong, et al. Research Progress of Heart Failure with Supra-normal Ejection Fraction[J]. Chinese General Practice, 2025, 28(21): 2692-2696. DOI: 10.12114/j.issn.1007-9572.2024.0307.

参考文献 35

[1]	WANG H, CHAI K, DU M H, et al. Prevalence and incidence of heart failure among urban patients in China：a national population-based analysis[J]. Circ Heart Fail，2021，14(10)：e008406. DOI：10.1161/CIRCHEARTFAILURE.121.008406.
[2]	国家心血管病中心，国家心血管病专家委员会心力衰竭专业委员会，中国医师协会心力衰竭专业委员会，等. 国家心力衰竭指南2023[J]. 中华心力衰竭和心肌病杂志，2023，7(4)：215-311.
[3]	PAONESSA J R, BRENNAN T, PIMENTEL M, et al. Hyperdynamic left ventricular ejection fraction in the intensive care unit[J]. Crit Care，2015，19(1)：288.
[4]	WEHNER G J, JING L Y, HAGGERTY C M, et al. Routinely reported ejection fraction and mortality in clinical practice：where does the nadir of risk lie?[J]. Eur Heart J，2020，41(12)：1249-1257. DOI：10.1093/eurheartj/ehz550.
[5]	STEWART S, PLAYFORD D, SCALIA G M, et al. Ejection fraction and mortality：a nationwide register-based cohort study of 499 153 women and men[J]. Eur J Heart Fail，2021，23(3)：406-416. DOI：10.1002/ejhf.2047.
[6]	郝潇，赵美，李树仁. STEMI直接PCI术后合并超常射血分数患者LVEF临界值及其可能机制初探[J]. 中国全科医学，2022，25(5)：547-553. DOI：10.12114/j.issn.1007-9572.2021.01.051.
[7]	ONO R, FALCÃO L M. Supra-normal left ventricular function[J]. Am J Cardiol，2023，207：84-92. DOI：10.1016/j.amjcard.2023.08.169.
[8]	HORIUCHI Y, ASAMI M, IDE T, et al. Prevalence，characteristics and cardiovascular and non-cardiovascular outcomes in patients with heart failure with supra-normal ejection fraction：insight from the JROADHF study[J]. Eur J Heart Fail，2023，25(7)：989-998. DOI：10.1002/ejhf.2895.
[9]	ROSCH S, KRESOJA K P, BESLER C, et al. Characteristics of heart failure with preserved ejection fraction across the range of left ventricular ejection fraction[J]. Circulation，2022，146(7)：506-518. DOI：10.1161/CIRCULATIONAHA.122.059280.
[10]	GEBHARD C, MAREDZIAK M, MESSERLI M, et al. Increased long-term mortality in women with high left ventricular ejection fraction：data from the CONFIRM（COronary CT angiography EvaluatioN for clinical outcomes：an InteRnational multicenter）long-term registry[J]. Eur Heart J Cardiovasc Imaging，2020，21(4)：363-374. DOI：10.1093/ehjci/jez321.
[11]	KONDO T, DEWAN P, ANAND I S, et al. Clinical characteristics and outcomes in patients with heart failure：are there thresholds and inflection points in left ventricular ejection fraction and thresholds justifying a clinical classification?[J]. Circulation，2023，148(9)：732-749. DOI：10.1161/CIRCULATIONAHA.122.063642..
[12]	VERBRUGGE F H, OMOTE K, REDDY Y N V, et al. Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels is associated with increased morbidity and mortality[J]. Eur Heart J，2022，43(20)：1941-1951. DOI：10.1093/eurheartj/ehab911.
[13]	FORREST I S, ROCHELEAU G, BAFNA S, et al. Genetic and phenotypic profiling of supranormal ejection fraction reveals decreased survival and underdiagnosed heart failure[J]. Eur J Heart Fail，2022，24(11)：2118-2127. DOI：10.1002/ejhf.2482.
[14]	CAMPBELL P, RUTTEN F H, LEE M M, et al. Heart failure with preserved ejection fraction：everything the clinician needs to know[J]. Lancet，2024，403(10431)：1083-1092. DOI：10.1016/S0140-6736(23)02756-3.
[15]	BORLAUG B A, SHARMA K, SHAH S J. Heart failure with preserved ejection fraction[J]. Journal of the American College of Cardiology，2023，81(18)：1810-1834.
[16]	SHAH S, SEGAR M W, KONDAMUDI N, et al. Supranormal left ventricular ejection fraction，stroke volume，and cardiovascular risk：findings from population-based cohort studies[J]. JACC Heart Fail，2022，10(8)：583-594. DOI：10.1016/j.jchf.2022.05.007.
[17]	DE MARCO M, GERDTS E, MANCUSI C, et al. Influence of left ventricular stroke volume on incident heart failure in a population with preserved ejection fraction（from the strong heart study）[J]. Am J Cardiol，2017，119(7)：1047-1052. DOI：10.1016/j.amjcard.2016.12.011.
[18]	RUSH C J, BERRY C, OLDROYD K G, et al. Prevalence of coronary artery disease and coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction[J]. JAMA Cardiol，2021，6(10)：1130-1143. DOI：10.1001/jamacardio.2021.1825.
[19]	WU P, ZHANG X L, WU Z F, et al. Impaired coronary flow reserve in patients with supra-normal left ventricular ejection fraction at rest[J]. Eur J Nucl Med Mol Imaging，2022，49(7)：2189-2198. DOI：10.1007/s00259-021-05566-y.
[20]	HAIDER A, BENGS S, MAREDZIAK M, et al. Heart rate reserve during pharmacological stress is a significant negative predictor of impaired coronary flow reserve in women[J]. Eur J Nucl Med Mol Imaging，2019，46(6)：1257-1267.
[21]	TAQUETI V R, SOLOMON S D, SHAH A M, et al. Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction[J]. Eur Heart J，2018，39(10)：840-849. DOI：10.1093/eurheartj/ehx721.
[22]	MAREDZIAK M, BENGS S, PORTMANN A, et al. Microvascular dysfunction and sympathetic hyperactivity in women with supra-normal left ventricular ejection fraction（snLVEF）[J]. Eur J Nucl Med Mol Imaging，2020，47(13)：3094-3106. DOI：10.1007/s00259-020-04892-x.
[23]	HAIDER A, BENGS S, WARNOCK G, et al. Age-dependent cardiac remodelling-role of sex hormones[J]. Eur Heart J，2020，41(Supplement_2)：ehaa946.3194. DOI：10.1093/ehjci/ehaa946.3194.
[24]	OLIVETTI G, GIORDANO G, CORRADI D, et al. Gender differences and aging：effects on the human heart[J]. J Am Coll Cardiol，1995，26(4)：1068-1079.
[25]	BURGER I A, LOHMANN C, MESSERLI M, et al. Age- and sex-dependent changes in sympathetic activity of the left ventricular apex assessed by 18F-DOPA PET imaging[J]. PLoS One，2018，13(8)：e0202302. DOI：10.1371/journal.pone.0202302.
[26]	BURKERT P, CARSTEN T, DE B R A, et al. How to diagnose heart failure with preserved ejection fraction：the HFA-PEFF diagnostic algorithm：a consensus recommendation from the Heart Failure Association（HFA）of the European Society of Cardiology（ESC）[J]. European Heart Journal，2019，40(40)：3297-3317. DOI：10.1093/eurheartj/ehz641.
[27]	KOUTROUMPAKIS E, KAUR R, TAEGTMEYER H, et al. Obesity and heart failure with preserved ejection fraction[J]. Heart Fail Clin，2021，17(3)：345-356. DOI：10.1016/j.hfc.2021.02.003.
[28]	REDDY Y N V, CARTER R E, OBOKATA M, et al. A simple，evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction[J]. Circulation，2018，138(9)：861-870. DOI：10.1161/CIRCULATIONAHA.118.034646.
[29]	SANDERS-VAN WIJK S, BARANDIARÁN AIZPURUA A, BRUNNER-LA ROCCA H P, et al. The HFA-PEFF and H2 FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction[J]. Eur J Heart Fail，2021，23(5)：838-840. DOI：10.1002/ejhf.2019.
[30]	MCDONAGH T A, METRA M, ADAMO M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J，2021，42(36)：3599-3726.
[31]	MCDONAGH T A, METRA M, ADAMO M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J，2023，44(37)：3627-3639. DOI：10.1093/eurheartj/ehad195.
[32]	VAN ESSEN B J, TROMP J, TER MAATEN J M, et al. Characteristics and clinical outcomes of patients with acute heart failure with a supranormal left ventricular ejection fraction[J]. Eur J Heart Fail，2023，25(1)：35-42. DOI：10.1002/ejhf.2695.
[33]	BUTLER J, PACKER M, FILIPPATOS G, et al. Effect of empagliflozin in patients with heart failure across the spectrum of left ventricular ejection fraction[J]. Eur Heart J，2022，43(5)：416-426. DOI：10.1093/eurheartj/ehab798.
[34]	SOLOMON S D, MCMURRAY J J V, ANAND I S, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction[J]. N Engl J Med，2019，381(17)：1609-1620. DOI：10.1056/NEJMoa1908655.
[35]	SOLOMON S D, VADUGANATHAN M, CLAGGETT B L, et al. Sacubitril/valsartan across the spectrum of ejection fraction in heart failure[J]. Circulation，2020，141(5)：352-361. DOI：10.1161/CIRCULATIONAHA.119.044586.