New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes

作者：Senni Michele; Paulus Walter J; Gavazzi Antonello; Fraser Alan G; Diez Javier; Solomon Scott D; Smiseth Otto A; Guazzi Marco; Lam Carolyn S P; Maggioni Aldo P; Tschoepe Carsten; Metra Marco; Hummel Scott L; Edelmann Frank; Ambrosio Giuseppe; Coats Andrew J Stewart; Filippatos Gerasimos S; Gheorghiade Mihai; Anker Stefan D; Levy Daniel; Pfeffer Marc A; Stough Wendy Gattis; Pieske Burkert M^*

来源：European Heart Journal, 2014, 35(40): 2797-2811.

DOI：10.1093/eurheartj/ehu204

• Heart failure, Diastolic
• Clinical trial
• Diabetes mellitus
• Exercise tolerance
• Phenotype
• Preserved ejection fraction

The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed.

• 出版日期2014-10-21
• 单位Perugia; 西北大学