既定和新兴的药理选择以及HFpEF和HFmrEF的未满足需求
Andrew J Sauer1,2, Jozine M Ter Maaten3, Gianluigi Savarese4
1Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
ESC heart failure
|February 19, 2026
概括
针对心力衰竭的新疗法正在出现,其中包括保留喷射分数 (HFpEF) 和轻微减少喷射分数 (HFmrEF). -葡萄糖共运输体2抑制剂和其他药物在改善这些具有挑战性的心力衰竭亚型的结果方面表现有前途.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 由于指导方针导向疗法,心力衰竭与减少喷射率 (HFrEF) 的死亡率有所降低.
- 尽管心脏衰竭事件的负担很大,但心脏衰竭的有效治疗方法仍然有限,其中包括心脏衰竭与保存的喷射分数 (HFpEF) 和心脏衰竭与轻微减少的喷射分数 (HFmrEF).
- 对于HFpEF和HFmrEF而言,有必要制定新的治疗策略.
研究的目的:
- 对HFpEF和HFmrEF的现有景观和新兴疗法进行审查.
- 为了突出-葡萄糖共运输体2抑制剂在HFpEF和HFmrEF中的有效性.
- 讨论其他药物类别和表型特定治疗的潜在作用.
主要方法:
- 对HFpEF和HFmrEF中各种药理学药物的临床试验数据和子分析的审查.
- 检查针对特定表型的新兴疗法,如肥胖和慢性病.
- 包括来自FINEARTS-HF,REDEFINE-HF,CONFIRMATION-HF等试验的数据,以及对GLP-1RA和双重激动剂的研究.
主要成果:
- -葡萄糖共运输体2抑制剂已证明在改善HFpEF和HFmrEF的结果方面具有有效性.
- 虽然不是主要的结局,但细分分析表明,氨酸-血管激素系统抑制剂,RNAI和类固醇MRA可能会减少HF住院或死亡率.
- 芬瑞诺在EF≥40%的HF患者中减少了HF事件和心血管死亡.
- GLP-1 RAs (西马格卢提德) 和双重GIP/GLP-1 RAs (蒂尔泽帕提德) 影响了HFpEF肥胖患者的HF住院和生活质量.
- 针对选择性矿物质皮质激素调节剂和阿尔多氨酸合成酶抑制剂的正在进行的试验旨在解决证据缺口.
结论:
- -葡萄糖共运输体2抑制剂代表了HFpEF和HFmrEF的显著进展.
- 对表型特异性治疗的进一步研究,包括针对肥胖和CKD的治疗,至关重要.
- 新兴的药物,如finerenone,balcinrenone和vicadrostat,有望改善HFpEF和HFmrEF的结果.
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