[Role of inflammation in heart failure with preserved ejection fraction: from nephro-metabolic interactions to future therapeutic implications].

IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Emilia D'Elia, Manuela Benvenuto, Ilaria Battistoni, Marco Cittar, Gianluigi Tagliamonte, Daniele Masarone, Geza Halasz, Raul Limonta, Luisa De Gennaro, Renata De Maria, Samuela Carigi, Matteo Bianco, Concetta Di Nora, Paolo Manca, Maria Vittoria Matassini, Vittoria Rizzello, Vittorio Palmieri, Claudio Bilato, Giovanna Geraci, Mauro Gori, Furio Colivicchi, Massimo Grimaldi, Fabrizio Oliva, Massimo Iacoviello
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引用次数: 0

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical entity frequently associated with chronic kidney disease (CKD). Recent studies indicate that 50-60% of HFpEF patients also have CKD, and the prevalence of HFpEF among CKD patients is similarly high. Chronic low-grade systemic inflammation is common to both conditions and is linked to risk factors such as obesity, insulin resistance, and diabetes. The hyperactivation of the mineralocorticoid receptor plays a central role in this process, contributing to interstitial fibrosis and inflammation. Additional factors, including metabolic acidosis, gut dysbiosis, and reduced expression of the α-Klotho protein, amplify the inflammatory response. This systemic inflammation reduces nitric oxide production, impairing cardiac diastolic function and, together with metabolic syndrome and aging, further exacerbates the already complex cardiac pathology. Therapeutic strategies aimed at reducing inflammation, such as renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter 2 inhibitors, show promising potential. Additionally, the use of anti-inflammatory drugs and novel interventions to restore gut microbiota balance may offer new opportunities to improve prognosis in patients with HFpEF and CKD. Further studies are needed to clarify the clinical efficacy of these approaches and their role in optimizing the management of this complex patient population.

[炎症在保留射血分数的心力衰竭中的作用:从肾代谢相互作用到未来的治疗意义]。
心力衰竭伴射血分数保留(HFpEF)是一种复杂的临床症状,常与慢性肾脏疾病(CKD)相关。最近的研究表明,50-60%的HFpEF患者同时患有CKD,并且HFpEF在CKD患者中的患病率也同样很高。慢性低度全身性炎症在这两种疾病中都很常见,并且与肥胖、胰岛素抵抗和糖尿病等风险因素有关。矿化皮质激素受体的过度激活在这一过程中起着核心作用,导致间质纤维化和炎症。其他因素,包括代谢性酸中毒、肠道生态失调和α-Klotho蛋白表达减少,都加剧了炎症反应。这种全身性炎症减少了一氧化氮的产生,损害了心脏舒张功能,并与代谢综合征和衰老一起,进一步加剧了本已复杂的心脏病理。旨在减少炎症的治疗策略,如肾素-血管紧张素-醛固酮系统抑制剂和钠-葡萄糖共转运蛋白2抑制剂,显示出良好的潜力。此外,使用抗炎药物和新的干预措施来恢复肠道微生物群平衡可能为改善HFpEF和CKD患者的预后提供新的机会。需要进一步的研究来阐明这些方法的临床疗效及其在优化这一复杂患者群体管理中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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Giornale italiano di cardiologia
Giornale italiano di cardiologia CARDIAC & CARDIOVASCULAR SYSTEMS-
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