[1]张啸,刘剑刚,董国菊.射血分数保留性心力衰竭常见合并症的病理机制及治疗策略[J].心血管病学进展,2024,(2):125.[doi:10.16806/j.cnki.issn.1004-3934.2023.02.007]
 ZHANG Xiao,LIU Jiangang.The Pathophysiology and Treatment Strategies of Comorbidities in HFpEF[J].Advances in Cardiovascular Diseases,2024,(2):125.[doi:10.16806/j.cnki.issn.1004-3934.2023.02.007]
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射血分数保留性心力衰竭常见合并症的病理机制及治疗策略()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2024年2期
页码:
125
栏目:
综述
出版日期:
2024-02-25

文章信息/Info

Title:
The Pathophysiology and Treatment Strategies of Comorbidities in HFpEF
作者:
张啸刘剑刚董国菊
(1.中国中医科学院西苑医院,国家中医临床心血管病医学研究中心,北京 100091;2.中国中医科学院研究生院,北京 100700)
Author(s):
ZHANG Xiao12LIU Jiangang1
(1.Xiyuan Hospital, China Academy of Chinese Medical Sciences, National Center for Clinical Cardiovascular Disease of Traditional Chinese Medicine, Beijing 100091, China;2.Graduate School of China Academy of Chinese Medical Sciences, Beijing 100700, China)
关键词:
射血分数保留性心力衰竭高血压糖尿病病理机制治疗方针
Keywords:
Heart failure with preserved ejection fractionHypertensionDiabetes mellitusPathological mechanismTreatment guidelines
DOI:
10.16806/j.cnki.issn.1004-3934.2023.02.007
文献标志码:
A
摘要:
射血分数保留的心力衰竭(HFpEF)病理生理机制尚未明确,目前认为与晚期糖基化终末产物-糖基化终末产物受体(AGEs-RAGE)、细胞自噬、氧化应激、炎症因子及mRNA功能等相关。高血压、糖尿病、冠心病、房颤等均可通过各种信号途径致使左室心肌僵硬度增加、舒张期充盈受损等病理改变,最终导致HFpEF的发生。目前研究显示能够改善HFpEF预后的药物主要为钠葡萄糖共转运蛋白2抑制剂(SGLT2i),而HFrEF的治疗手段也并不适用于HFpEF,故通过对其合发症进行早期预防及治疗,以此控制HFpEF的发生发展显得尤为重要,本文从HFpEF常见合并症的病理机制及治疗等方面进行归纳,以期为HFpEF的临床治疗提供借鉴和指导。
Abstract:
The pathophysiological mechanisms of heart failure with preserved ejection fraction (HFpEF) are not well defined and are thought to be related to advanced glycosylation end products-glycosylation end product receptors (AGEs-RAGE),cellular autophagy,oxidative stress,inflammatory factors,and mRNA function.Hypertension,diabetes,coronary artery disease,and atrial fibrillation can lead to increased left ventricular myocardial stiffness and impaired diastolic filling through various pathways to promote HFpEF.Current studies have shown that the drug which can improve HFpEF is mainly sodium glucose cotransport protein 2 inhibitors (SGLT2i),and the treatment of HFrEF is not applicable to HFpEF,so it is important to control the development of HFpEF by early prevention and treatment of its comorbidities.This paper reviews the pathological mechanisms and treatment of the common comorbidities of HFpEF to help the clinical management of HFpEF.

参考文献/References:

[1] Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction[J]. Nat Rev Cardiol,2020,17(9):559-573.[2] Kittleson MM,Panjrath GS,Amancherla K,et al. 2023 ACC Expert Consensus decision pathway on management of heart failure with preserved ejection fraction:a report of the American College of Cardiology Solution Set Oversight Committee[J]. J Am Coll Cardiol,2023,81(18):1835-1878.[3] Teuber JP,Essandoh K,Hummel SL,et al. NADPH oxidases in diastolic dysfunction and heart failure with preserved ejection fraction[J]. Antioxidants (Basel),2022,11(9):1822.[4] Budde H,Hassoun R,Mugge A,et al. Current understanding of molecular pathophysiology of heart failure with preserved ejection fraction[J]. Front Physiol,2022,13:928232.[5] Liang BR,Zhou Z,Yang ZQ,et al. AGEs-RAGE axis mediates myocardial fibrosis via activation of cardiac fibroblasts induced by autophagy in heart failure[J]. Exp Physiol,2022,107(8):879-891.[6] Rush CJ,Berry C,Oldroyd KG,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.[7] Simmonds SJ,Cuijpers I,Heymans S,et al. Cellular and molecular differences between HFpEF and HFrEF:a step ahead in an improved pathological understanding[J]. Cells,2020,9(1):242.[8] Schiattarella GG,Rodolico D,Hill JA. Metabolic inflammation in heart failure with preserved ejection fraction[J]. Cardiovasc Res,2021,117(2):423-434.[9] Capone F,Sotomayor-Flores C,Bode D,et al. Cardiac metabolism in HFpEF:from fuel to signalling[J]. Cardiovasc Res,2023,118(18):3556-3575.[10] Challa AA,Lewandowski ED. Short-chain carbon sources:exploiting pleiotropic effects for heart failure therapy[J]. JACC Basic Transl Sci,2022,7(7):730-742.[11] Son TK,Toan NH,Thang N,et al. Prediabetes and insulin resistance in a population of patients with heart failure and reduced or preserved ejection fraction but without diabetes,overweight or hypertension[J]. Cardiovasc Diabetol,2022,21(1):75.[12] Verhaert DVM,Brunner-La Rocca HP,van Veldhuisen DJ,et al. The bidirectional interaction between atrial fibrillation and heart failure:consequences for the management of both diseases[J]. Europace,2021,23(23 suppl 2):ii40-ii45.[13] Mone P,Lombardi A,Kansakar U,et al. Empagliflozin improves the microRNA signature of endothelial dysfunction in patients with HFpEF and diabetes[J]. J Pharmacol Exp Ther,2023,384(1):116-122.[14] Defronzo RA,Reeves WB,Awad AS. Pathophysiology of diabetic kidney disease:impact of SGLT2 inhibitors[J]. Nat Rev Nephrol,2021,17(5):319-334.[15] Lewis GA,Dodd S,Clayton D,et al. Pirfenidone in heart failure with preserved ejection fraction:a randomized phase 2 trial[J]. Nat Med,2021,27(8):1477-1482.[16] Deng Y,Xie M,Li Q,et al. Targeting mitochondria-inflammation circuit by beta-hydroxybutyrate mitigates HFpEF[J]. Circ Res,2021,128(2):232-245.[17] Hatahet J,Cook TM,Bonomo RR,et al. Fecal microbiome transplantation and tributyrin improves early cardiac dysfunction and modifies the BCAA metabolic pathway in a diet induced pre-HFpEF mouse model[J]. Front Cardiovasc Med,2023,10:1105581.[18] Zhang L,Chen J,Yan L,et al. Resveratrol ameliorates cardiac remodeling in a murine model of heart failure with preserved ejection fraction[J]. Front Pharmacol,2021,12:646240.[19]李兵达. Adropin在射血分数保留型心衰中的作用及机制[D].江西:南昌大学,2022.[20] Shah SJ,Borlaug BA,Chung ES,et al. Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF Ⅱ):a randomised,multicentre,blinded,sham-controlled trial[J]. Lancet,2022,399(10330):1130-1140.[21] Schnelle M,Leha A,Eidizadeh A,et al. Plasma biomarker profiling in heart failure patients with preserved ejection fraction before and after spironolactone treatment:results from the Aldo-DHF trial[J]. Cells,2021,10(10):2796.[22] Jackson AM,Jhund PS,Anand IS,et al. Sacubitril-valsartan as a treatment for apparent resistant hypertension in patients with heart failure and preserved ejection fraction[J]. Eur Heart J,2021,42(36):3741-3752.[23] Ledwidge M,Dodd JD,Ryan F,et al. Effect of sacubitril/valsartan vs valsartan on left atrial volume in patients with pre-heart failure with preserved ejection fraction:the PARABLE randomized clinical trial[J]. JAMA Cardiol,2023,8(4):366-375.[24] Patel K,Fonarow GC,Ahmed M,et al. Calcium channel blockers and outcomes in older patients with heart failure and preserved ejection fraction[J]. Circ Heart Fail,2014,7(6):945-952.[25] Wang X,Ju J,Chen Z,et al. Associations between calcium channel blocker therapy and mortality in heart failure with preserved ejection fraction[J]. Eur J Prev Cardiol,2022,29(9):1343-1351.[26] Jarrar YB,Jarrar Q,Abaalkhail SJ,et al. Molecular toxicological alterations in the mouse hearts induced by sub-chronic thiazolidinedione drugs administration[J]. Fundam Clin Pharmacol,2022,36(1):143-149.[27] Liu J,Hu X. Impact of insulin therapy on outcomes of diabetic patients with heart failure:a systematic review and meta-analysis[J]. Diab Vasc Dis Res,2022,19(3):14791641221093175.[28] Li J,Minczuk K,Massey JC,et al. Metformin improves cardiac metabolism and function,and prevents left ventricular hypertrophy in spontaneously hypertensive rats[J]. J Am Heart Assoc,2020,9(7):e015154.[29] Dia M,Leon C,Chanon S,et al. Effect of metformin on T2D-induced MAM Ca2+ uncoupling and contractile dysfunction in an early mouse model of diabetic HFpEF[J]. Int J Mol Sci,2022,23(7):3569.[30] Voros I,Onodi ZS,Toth VE,et al. Investigation of cardiotoxicity by dipeptidyl-peptidase-4 inhibitors in a human cardiomyocyte cell line as well as in samples from chronic heart failure patients[J]. Cardiovasc Res,2022,118(suppl 1):1.[31] Mu L,Wang Z,Ren J,et al. Impact of DPP-4 inhibitors on plasma levels of BNP and NT-pro-BNP in type 2 diabetes mellitus[J]. Diabetol Metab Syndr,2022,14(1):30.[32] Zakaria EM,Tawfeek WM,Hassanin MH,et al. Cardiovascular protection by DPP-4 inhibitors in preclinical studies:an updated review of molecular mechanisms[J]. Naunyn Schmiedebergs Arch Pharmacol,2022,395(11):1357-1372.[33] Withaar C,Meems LMG,Markousis-Mavrogenis G,et al. The effects of liraglutide and dapagliflozin on cardiac function and structure in a multi-hit mouse model of heart failure with preserved ejection fraction[J]. Cardiovasc Res,2021,117(9):2108-2124.[34] Filippatos G,Butler J,Farmakis D,et al. Empagliflozin for heart failure with preserved left ventricular ejection fraction with and without diabetes[J]. Circulation,2022,146(9):676-686.[35]黄鑫涛,白保强,李之恒,等. 不同剂量瑞舒伐他汀对老年高血压并射血分数保留型慢性心力衰竭患者心室重构的影响[J]. 重庆医科大学学报,2022,47(1):66-73.[36] Park JJ,Yoon M,Cho HW,et al. C-reactive protein and statins in heart failure with reduced and preserved ejection fraction[J]. Front Cardiovasc Med,2022,9:1064967.[37] Zelniker TA,Bonaca MP,Furtado RHM,et al. Effect of dapagliflozin on atrial fibrillation in patients with type 2 diabetes mellitus:insights from the DECLARE-TIMI 58 trial[J]. Circulation,2020,141(15):1227-1234.[38] Li LY,Lou Q,Liu GZ,et al. Sacubitril/valsartan attenuates atrial electrical and structural remodelling in a rabbit model of atrial fibrillation[J]. Eur J Pharmacol,2020,881:173120.[39] Zhu X,Wu Y,Ning Z. Meta-analysis of catheter ablation versus medical therapy for heart failure complicated with atrial fibrillation[J]. Cardiol Res Pract,2021,2021:7245390.[40] Gu MJ,Hyon JY,Lee HW,et al. Glycolaldehyde,an advanced glycation end products precursor,induces apoptosis via ROS-mediated mitochondrial dysfunction in renal mesangial cells[J]. Antioxidants (Basel),2022,11(5):934.[41] Senatus L,Maclean M,Arivazhagan L,et al. Inflammation meets metabolism:roles for the receptor for advanced glycation end products axis in cardiovascular disease[J]. Immunometabolism,2021,3(3):e210024.[42] Sun J,Xu J,Yang Q. Expression and predictive value of NLRP3 in patients with atrial fibrillation and stroke[J]. Am J Transl Res,2022,14(5):3104-3112.[43] Wang S,Zhang J,Wang Y,et al. NLRP3 inflammasome as a novel therapeutic target for heart failure[J]. Anatol J Cardiol,2022,26(1):15-22.

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更新日期/Last Update: 2024-03-29