Heart failure with preserved ejection fraction: an update on pathophysiology, diagnosis, treatment, and prognosis

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF with normal or near-normal left ventricular ejection fraction (LVEF ≥50%). Roughly half of all patients with HF worldwide have an LVEF ≥50% and nearly half have an LVEF <50%. Thanks to the increased scientific attention about the condition and improved characterization and diagnostic tools, the incidence of HF with reduced ejection fraction (HFrEF) dropped while that of HFpEF has increased by 45%. HFpEF has no single guideline for diagnosis or treatment, the patient population is heterogeneously and inconsistently described, and longitudinal studies are lacking. To better understand and overcome the disease, in this review, we updated the latest knowledge of HFpEF pathophysiology, introduced the existing promising diagnostic methods and treatments, and summarized its prognosis by reviewing the most recent cohort studies.

射血分数保留型心力衰竭（heart failure with preserved ejection fraction, HFpEF）是一类临床综合征，患者存在心力衰竭（heart failure, HF）的症状与体征，且左心室射血分数（left ventricular ejection fraction, LVEF）处于正常或接近正常范围（LVEF ≥50%）。全球范围内约半数心力衰竭患者的LVEF ≥50%，近半数患者的LVEF <50%。得益于学界对该病症关注度的提升，以及疾病表征与诊断工具的优化，射血分数降低型心力衰竭（heart failure with reduced ejection fraction, HFrEF）的发病率有所下降，而HFpEF的发病率则上升了45%。目前HFpEF尚无统一的诊断或治疗指南，患者群体异质性显著且相关描述缺乏一致性，纵向研究较为匮乏。为进一步深入认识并攻克该疾病，本综述梳理了HFpEF病理生理学领域的最新研究进展，介绍了当前颇具应用前景的诊断方法与治疗手段，并通过回顾最新队列研究总结了该疾病的预后情况。