用保存的喷射部分对心力衰竭的表型特异性治疗:多器官路线图
Sanjiv J Shah1, Dalane W Kitzman1, Barry A Borlaug1
1From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.).
用保存喷射分数 (HFpEF) 治疗心力衰竭需要解决并发症和多种表型. 个性化策略针对HFpEF特定的信号通路,以改善结果.
科学领域:
- 心脏病学
- 内部医学
- 翻译研究
背景情况:
- 心脏衰竭与保存的喷射分数 (HFpEF) 是一个日益严重的临床挑战,占心脏衰竭病例的50%.
- 与减少喷射分数的HF不同,HFpEF对传统的神经幽默抑制疗法表现出耐药性.
- 独特的系统和心肌信号通路,以及表型多样性,有助于HFpEF的复杂性.
研究的目的:
- 提出一种新的HFpEF处理策略,考虑到其特定的信号机制和表型变异.
- 阐明心脏外伴随性疾病在HFpEF中推动心脏重塑和功能障碍的作用.
- 在已识别的信号级联中确定潜在的治疗目标.
主要方法:
- 对HFpEF病理生理学的当前文献的综述,重点是系统性炎症和内皮功能障碍.
- 分析将共患病 (代谢风险,高血压,功能衰竭) 与心脏重塑联系起来的信号通路.
- 在HFpEF中探索针对特定分子和细胞过程的针对性干预措施.
主要成果:
- 外心并发症通过全身炎症和冠状动脉微血管内皮功能障碍驱动HFpEF.
- 这些机制导致左心室扩张功能障碍,间歇性纤维化和心肌细胞硬化.
- 确定了多种治疗点,包括卡路里限制,他类药物,PDE5抑制剂,运动,利尿剂,酸盐-酸盐, neprilysin/ PDE9抑制剂和螺旋.
结论:
- 由于其表型多样性,个性化治疗方法对于管理HFpEF至关重要.
- 针对HFpEF特定的信号级联为治疗开发提供了一个有前途的途径.
- 考虑HFpEF表现和倾向的矩阵方法可以指导个性化治疗选择.
相关概念视频
Heart Failure V: Medical Management
Heart Failure IV: Classification and Diagnostic Evaluation
Heart Failure VI: Adjunct Therapies
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
Pathophysiology of Heart Failure
Cardiomyopathy V: Interprofessional Care


