Cardiometabolic HFpEF: Mechanisms and Therapies

G. Schiattarella, Joseph A. Hill
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Abstract

Heart failure with preserved ejection fraction (HFpEF) accounts for at least half of all patients with heart failure (HF) and is projected to be the most common form of HF in the near feature. HFpEF, characterized by high morbidity and mortality, poses an enormous medical and societal burden and lacks evidence-based therapies. Hence, HFpEF has been recognized as the greatest unmet need in cardiovascular medicine. HFpEF is a heterogenous syndrome presenting as several different clinical phenotypes. Among these, metabolic alterationdriven HFpEF—i.e. cardiometabolic HFpEF—is emerging around the globe as the most prevalent form of HFpEF. Pathophysiological mechanisms of cardiometabolic HFpEF are still incompletely understood. However, recent advances in the preclinical modeling of the syndrome, coupled with better definition of its clinical presentations and analysis of human HFpEF myocardial specimens, have unveiled metabolic disturbances and inflammatory burden as 2 key drivers of HFpEF pathophysiology. Here, we summarize evidence in support of a cardiometabolic phenotype of HFpEF and discuss the pivotal biological mechanisms underlying this syndrome in the hope of informing more efficacious therapeutic approaches in the future.
心脏代谢HFpEF:机制和治疗
保留射血分数的心力衰竭(HFpEF)占所有心力衰竭(HF)患者的至少一半,并且预计在近特征中是最常见的心力衰竭形式。HFpEF的特点是发病率和死亡率高,造成巨大的医疗和社会负担,缺乏循证治疗。因此,HFpEF已被认为是心血管医学中最大的未满足需求。HFpEF是一种异质性综合征,表现为几种不同的临床表型。其中,代谢改变驱动的hfpef,即。心脏代谢性HFpEF正在全球范围内成为最普遍的HFpEF形式。心脏代谢HFpEF的病理生理机制尚不完全清楚。然而,该综合征的临床前建模的最新进展,加上对其临床表现的更好定义和对人类HFpEF心肌标本的分析,揭示了代谢紊乱和炎症负担是HFpEF病理生理的两个关键驱动因素。在这里,我们总结了支持HFpEF心脏代谢表型的证据,并讨论了该综合征的关键生物学机制,以期为未来更有效的治疗方法提供信息。
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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