Heart Failure with Preserved Ejection Fraction：Diagnosis and Treatment Strategies

doi:10.12114/j.issn.1007-9572.2020.00.603

Abstract

Abstract: HFpEF accounts for about 50% of heart failure cases.With the aging of population，its incidence and mortality tend to increase year by year.On the basis of recent developments and recommendations from definitive guidelines/ consensuses regarding HFpEF，we introduced and analyzed the diagnostic procedures and treatment strategies for HFpEF，aiming to provide assistance and guidance to Chinese primary care physicians.However，we believe that there are still many problems and challenges in this field：the pathogenesis of HFpEF is still unclear，there is a lack of effective treatment methods，and a large number of clinical trials have shown negative results，and so on.Further clinical studies are needed to provide evidence for HFpEF treatment and reducing the incidence and mortality of related cardiovascular events.

Key words: Heart failure, Heart failure with ejection fraction, Diagnosis, Therapy, Guidebooks

摘要： 射血分数保留的心力衰竭（HFpEF）约占心力衰竭总数的50%，随着人口老龄化，其发病率及致死率有逐年上升的趋势。本文结合HFpEF目前的研究进展和权威指南/共识的推荐，分析和介绍了HFpEF诊断流程和治疗策略，以期对我国基层医生起到帮助和指导作用。同时，本文提出目前在该领域还面临着许多问题和挑战，如HFpEF的发病机制尚不明确、缺乏有效的治疗方法、大量临床试验结果呈阴性等，需要进一步的临床研究为HFpEF患者提供治疗依据，降低心血管事件的发生率和病死率。

关键词: 心力衰竭, 射血分数保留的心力衰竭, 诊断, 治疗, 指南

LIU Wei,WEI Ran. Heart Failure with Preserved Ejection Fraction：Diagnosis and Treatment Strategies　[J]. Chinese General Practice, 2021, 24(3): 253-258. DOI: 10.12114/j.issn.1007-9572.2020.00.603.
刘蔚,尉然. 射血分数保留的心力衰竭的诊断和治疗策略[J]. 中国全科医学, 2021, 24(3): 253-258. DOI: 10.12114/j.issn.1007-9572.2020.00.603.

References

［1］LAM C S，DONAL E，KRAIGHER-KRAINER E，et al．Epidemiology and clinical course of heart failure with preserved ejection fraction［J］．Eur J Heart Fail，2011，13（1）：18-28．DOI：10.1093/eurjhf/hfq121.
［2］OWAN T E，REDFIELD M M.Epidemiology of diastolic heart failure［J］．Prog Cardiovasc Dis，2005，47（5）：320-332．DOI：10.1016/j.pcad.2005.02.010.
［3］LIU D P，WANG F，ZENG X Z，et al．Clinical characteristics and prognosis of heart failure with normal left ventricular ejection fraction in elderly patients［J］．Chin Med J（Engl），2012，125（16）：2853-2857．
［4］张健，张宇辉，代表中国心力衰竭注册登记协作组．多中心、前瞻性中国心力衰竭注册登记研究——病因、临床热点和治疗情况初步分析［J］．中国循环杂志，2015，30（5）：413-416．
［5］MAGGIONI A P，DAHLSTR?M U，FILIPPATOS G，et al．EURObservational research programme：regional differences and 1-year follow-up results of the heart failure pilot survey（ESC-HF pilot）［J］．Eur J Heart Fail，2013，15（7）：808-817．DOI：10.1093/eurjhf/hft050.
［6］OWAN T E，HODGE D O，HERGES R M，et al．Trends in prevalence and outcome of heart failure with preserved ejection fraction［J］．N Engl J Med，2006，355（3）：251-259．DOI：10.1056/nejmoa052256.
［7］LEE D S，GONA P，VASAN R S，et al．Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction：insights from the Framingham heart study of the national heart，lung，and blood institute［J］．Circulation，2009，119（24）：3070-3077．DOI：10.1161/CIRCULATIONAHA.108.815944.
［8］SANTHANAKRISHNAN R，CHONG J P，NG T P，et al．Growth differentiation factor 15，ST2，high-sensitivity troponin T，and N-terminal pro brain natriuretic peptide in heart failure with preserved vs.reduced ejection fraction［J］．Eur J Heart Fail，2012，14（12）：1338-1347．DOI：10.1093/eurjhf/hfs130.
［9］CHENG J M，AKKERHUIS K M，BATTES L C，et al．Biomarkers of heart failure with normal ejection fraction：a systematic review［J］．Eur J Heart Fail，2013，15（12）：1350-1362．DOI：10.1093/eurjhf/hft106.
［10］SANDERS-VAN WIJK S，VAN EMPEL V，DAVARZANI N，et al．Circulating biomarkers of distinct pathophysiological pathways in heart failure with preserved vs.reduced left ventricular ejection fraction［J］．Eur J Heart Fail，2015，17（10）：1006-1014．DOI：10.1002/ejhf.414.
［11］D'ELIA E，VADUGANATHAN M，GORI M，et al．Role of biomarkers in cardiac structure phenotyping in heart failure with preserved ejection fraction：critical appraisal and practical use［J］．Eur J Heart Fail，2015，17（12）：1231-1239．DOI：10.1002/ejhf.430.
［12］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.
［13］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.
［14］ANDERSON J L，HALPERIN J L，ALBERT N M，et al．Management of patients with atrial fibrillation（compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations）：a report of the American College of Cardiology/American Heart Association Task force on practice guidelines［J］．J Am Coll Cardiol，2013，61（18）：1935-1944．DOI：10.1016/j.jacc.2013.02.001.
［15］YANCY C W，JESSUP M，BOZKURT B，et al．2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure：a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America［J］．Circulation，2017，136（6）：e137-161．DOI：10.1161/CIR.0000000000000509.
［16］CUNNINGHAM J W，VADUGANATHAN M，CLAGGETT B L，
et al．Effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide in heart failure with preserved ejection fraction［J］．JACC：Heart Fail，2020，8（5）：372-381．DOI：10.1016/j.jchf.2020.03.002.
［17］JAMES L，JANUZZI Jr，PEDER L，et al．The Challenges of NT-proBNP Testing in HFpEF：shooting arrows in the wind［J］．JACC：Heart Failure，2020，8（5）：382-385．DOI：10.1016/j.jchf.2020.03.003.
［18］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.
［19］UNGER T，BORGHI C，CHARCHAR F，et al．2020 International Society of Hypertension Global Hypertension Practice guidelines［J］．Hypertension，2020，75（6）：1334-1357．DOI：10.1161/HYPERTENSIONAHA.120.15026.
［20］YUSUF S，PFEFFER M A，SWEDBERG K，et al．Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction：the CHARM-Preserved Trial［J］．Lancet，2003，362（9386）：777-781．DOI：10.1016/S0140-6736（03）14285-7.
［21］RECTOR T S，CARSON P E，ANAND I S，et al．Assessment of long-term effects of irbesartan on heart failure with preserved ejection fraction as measured by the Minnesota living with heart failure questionnaire in the irbesartan in heart failure with preserved systolic function（I-PRESERVE） trial［J］．Circ Heart Fail，2012，5（2）：217-225．DOI：10.1161/CIRCHEARTFAILURE.111.964221.
［22］CLELAND J G F.The perindopril in elderly people with chronic heart failure（PEP-CHF） study［J］．Eur Heart J，2006，27（19）：2338-2345．DOI：10.1093/eurheartj/ehl250.
［23］YAMAMOTO K，ORIGASA H，HORI M，et al．Effects of carvedilol on heart failure with preserved ejection fraction：the Japanese Diastolic Heart Failure Study（J-DHF）［J］．Eur J Heart Fail，2013，15（1）：110-118．DOI：10.1093/eurjhf/hfs141.
［24］FLATHER M D，SHIBATA M C，COATS A J，et al．Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure（SENIORS）［J］．Eur Heart J，2005，26（3）：215-225．DOI：10.1093/eurheartj/ehi115.
［25］CONRAADS V M，METRA M，KAMP O，et al．Effects of the long-term administration of nebivolol on the clinical symptoms，exercise capacity，and left ventricular function of patients with diastolic dysfunction：results of the ELANDD study［J］．Eur J Heart Fail，2012，14（2）：219-225．DOI：10.1093/eurjhf/hfr161.
［26］FONAROW G C，STOUGH W G，ABRAHAM W T，et al．Characteristics，treatments，and outcomes of patients with preserved systolic function hospitalized for heart failure：a report from the OPTIMIZE-HF Registry［J］．J Am Coll Cardiol，2007，50（8）：768-777．DOI：10.1016/j.jacc.2007.04.064.
［27］AHMED A，RICH M W，FLEG J L，et al．Effects of digoxin on morbidity and mortality in diastolic heart failure：the ancillary Digitalis investigation group trial［J］．Circulation，2006，114（5）：397-403．DOI：10.1161/CIRCULATIONAHA.106.628347.
［28］PITT B，PFEFFER M A，ASSMANN S F，et al．Spironolactone for heart failure with preserved ejection fraction［J］．N Engl J Med，2014，370（15）：1383-1392．DOI：10.1056/NEJMoa1313731.
［29］REDFIELD M M，ANSTROM K J，LEVINE J A，et al．Isosorbide mononitrate in heart failure with preserved ejection fraction［J］．N Engl J Med，2015，373（24）：2314-2324．DOI：10.1056/nejmoa1510774.
［30］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.
［31］ARMSTRONG P W，PIESKE B，ANSTROM K J，et al．Vericiguat in patients with heart failure and reduced ejection fraction［J］．N Engl J Med，2020，382（20）：1883-1893．DOI：10.1056/NEJMoa1915928.
［32］PIESKE B，MAGGIONI A P，LAM C S P，et al．Vericiguat in patients with worsening chronic heart failure and preserved ejection fraction：results of the soluble guanylate cyclase stimulator in heart failure patients with PRESERVED EF（SOCRATES-PRESERVED） study［J］．Eur Heart J，2017，38（15）：1119-1127．DOI：10.1093/eurheartj/ehw593.
［33］KOSIBOROD M N，JHUND P S，DOCHERTY K F，et al．Effects of dapagliflozin on symptoms，function，and quality of life in patients with heart failure and reduced ejection fraction：results from the DAPA-HF trial［J］．Circulation，2020，141（2）：90-99．DOI：10.1161/CIRCULATIONAHA.119.044138.
［34］NASSIF M E，WINDSOR S L，TANG F M，et al．Dapagliflozin effects on biomarkers，symptoms，and functional status in patients with heart failure with reduced ejection fraction：the DEFINE-HF trial［J］．Circulation，2019，140（18）：1463-1476．DOI：10.1161/CIRCULATIONAHA.119.042929.
［35］HASENFU? G，HAYWARD C，BURKHOFF D，et al．A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction（REDUCE LAP-HF）：a multicentre，open-label，single-arm，phase 1 trial［J］．Lancet，2016，387（10025）：1298-1304．DOI：10.1016/S0140-6736（16）00704-2.
［36］ADAMSON P B，ABRAHAM W T，AARON M，et al．CHAMPION trial rationale and design：the long-term safety and clinical efficacy of a wireless pulmonary artery pressure monitoring system［J］．J Card Fail，2011，17（1）：3-10．DOI：10.1016/j.cardfail.2010.08.002.

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