Heart failure with preserved ejection fraction (HFpEF) is a complex clinical entity that is poorly understood yet present in up to 5.5% of the general population. Proven therapies for this disorder are lacking, even though it has a similar prognosis to that of heart failure with reduced ejection fraction (HFrEF). Innovative imaging techniques have provided in-depth understanding of the unique pattern of left ventricular mechanics in patients with HFpEF who progress through preclinical (Stages A to B) and clinical (Stages C to D) American College of Cardiology/American Heart Association heart failure stages. This review highlights the mechanical basis of this disorder from the cellular and myofiber level to chamber dysfunction. As each chamber of the heart is examined, specific biomarkers and echocardiographic parameters with diagnostic and prognostic values are discussed. Finally, novel phenotyping methods including machine learning are reviewed that integrate these mechanics into clinical groups to advise and treat patients.

译文

射血分数保留的心力衰竭 (HFpEF) 是一种复杂的临床实体,目前尚不清楚,但存在于多达5.5% 的普通人群中。尽管这种疾病的预后与射血分数降低的心力衰竭 (HFrEF) 相似,但缺乏针对这种疾病的可靠疗法。创新的成像技术为通过临床前 (A至B阶段) 和临床 (C至D阶段) 进展的HFpEF患者提供了对左心室力学独特模式的深入了解美国心脏病学会/美国心脏协会心力衰竭阶段。这篇评论强调了从细胞和肌纤维水平到腔室功能障碍的这种疾病的机械基础。在检查心脏的每个腔室时,将讨论具有诊断和预后价值的特定生物标志物和超声心动图参数。最后,回顾了包括机器学习在内的新型表型方法,这些方法将这些机制整合到临床组中,以建议和治疗患者。

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