Хроническая сердечная недостаточность с сохраненной фракцией выброса: современное состояние проблемы

Хроническая сердечная недостаточность с сохраненной фракцией выброса (СНсФВ) характеризуется широкой распространенностью и ассоциируется с высокой смертностью при отсутствии эффективных подходов к лечению. К настоящему времени ни один из исследованных лекарственных препаратов не показал своей способности модифицировать течение болезни. Отсутствие прогресса в лечении данного синдрома заставляет медицинское сообщество снова и снова изучать гетерогенную природу данного состояния и его патогенетические механизмы, а также пересматривать существующие диагностические подходы для СНсФВ. Сегодня сформировалось понимание того, что используемые диагностические критерии СНсФВ обладают недостаточной чувствительностью и специфичностью и могут влиять на результаты клинических исследований. В настоящее время предложены к рассмотрению новые диагностические алгоритмы, эффективность использования которых продолжает изучаться. Также поднимается ряд вопросов относительно оптимизации текущих терапевтических подходов, завершены ряд исследований по оценке новых групп препаратов у данной категории пациентов, обсуждаются дальнейшие перспективы в лечении. Все это сформировало предпосылки для анализа накопленной информации и послужило целью настоящего обзора.

1. Российское кардиологическое общество (РКО). Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский Кардиологический Журнал. 2020;25(11):4083. DOI:10.15829/1560-4071-2020-4083.

2. Мареев В.Ю., Фомин И.В., Агеев Ф.Т., и др. Клинические Рекомендации ОССНРКО-РНМОТ. Сердечная Недостаточность: Хроническая (ХСН) И Острая Декомпенсированная (ОДСН). Диагностика, Профилактика И Лечение. Кардиология. 2018;58(6S):8-158. DOI:10.18087/cardio.2475.

3. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-2200. DOI:10.1093/eurheartj/ehw128.

4. Pieske B, Tschöpe C, De Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: The HFA-PEFF diagnostic algorithm: A consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40(40):3297-317. DOI:10.1093/eurheartj/ehz641.

5. Brunner-La Rocca HP, Sanders-van Wijk S. BNP guided therapy review. Card Fail Rev. 2019;5(1):44.

6. Pfeffer MA, Claggett B, Assmann SF, et al. Regional variation in patients and outcomes in the treatment of preserved cardiac function heart failure with an aldosterone antagonist (TOPCAT) trial. Circulation. 2015;131(1):34-42. DOI:10.1161/CIRCULATIONAHA.114.013255.

7. Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2019;381(17):1609-20. DOI:10.1056/nejmoa1908655.

8. Meyer M, Lewinter MM. Heart rate and heart failure with preserved ejection fraction: Time to slow β-blocker use? Circ Hear Fail. 2019;12(8):1-5. DOI:10.1161/CIRCHEARTFAILURE.119.006213.

9. Ho JE, Zern EK, Wooster L, et al. Differential Clinical Profiles, Exercise Responses, and Outcomes Associated with Existing HFpEF Definitions. Circulation. 2019;140(5):353-65. DOI:10.1161/CIRCULATIONAHA.118.039136.

10. Borlaug BA, Nishimura RA, Sorajja P, et al. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Hear Fail. 2010;3(5):588-95. DOI:10.1161/CIRCHEARTFAILURE.109.930701.

11. Verbrugge FH, Guazzi M, Testani JM, Borlaug BA. Altered Hemodynamics and End-Organ Damage in Heart Failure: Impact on the Lung and Kidney. Circulation. Published online 2020:998-1012. DOI:10.1161/CIRCULATIONAHA.119.045409.

12. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314. DOI:10.1016/j.echo.2016.01.011.

13. Gustafsson F, Steensgaard-Hansen F, Badskjaer J, et al. Diagnostic and prognostic performance of N-terminal ProBNP in primary care patients with suspected heart failure. J Card Fail. 2005;11(5 Suppl):15-20. DOI:10.1016/j.cardfail.2005.04.022.

14. Anjan VY, Loftus TM, Burke MA, et al. Prevalence, clinical phenotype, and outcomes associated with normal B-type natriuretic peptide levels in heart failure with preserved ejection fraction. Am J Cardiol. 2012;110(6):870-6. DOI:10.1016/j.amjcard.2012.05.014.

15. Mueller C, McDonald K, de Boer RA, et al. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail. 2019;21(6):715-31. DOI:10.1002/ejhf.1494.

16. Ha JW, Andersen OS, Smiseth OA. Diastolic Stress Test: Invasive and Noninvasive Testing. JACC Cardiovasc Imaging. 2020;13(1):272-82. DOI:10.1016/j.jcmg.2019.01.037.

17. Pellicori P, Platz E, Dauw J, et al. Ultrasound imaging of congestion in heart failure: examinations beyond the heart. Eur J Heart Fail. 2020;10.1002/ejhf.2032. DOI:10.1002/ejhf.2032.

18. Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138(9):861-70. DOI:10.1161/CIRCULATIONAHA.118.034646.

19. Ezekowitz JA, Becher H, Belenkie I, et al. The Alberta Heart Failure Etiology and Analysis Research Team (HEART) study. BMC Cardiovasc Disord. 2014;14(1):1-9. DOI:10.1186/1471-2261-14-91.

20. Sepehrvand N, Alemayehu W, Dyck GJB, et al. External Validation of the H2F-PEF Model in Diagnosing Patients with Heart Failure and Preserved Ejection Fraction. Circulation. 2019;139(20):2377-2379. DOI:10.1161/CIRCULATIONAHA.118.038594.

21. Segar MW, Patel KV, Berry JD, et al. Generalizability and Implications of the H2FPEF Score in a Cohort of Patients with Heart Failure with Preserved Ejection Fraction: Insights from the TOPCAT Trial. Circulation. 2019;139(15):1851-1853. DOI:10.1161/CIRCULATIONAHA.118.039051

22. Barandiarán Aizpurua A, Sanders-van Wijk S, Brunner-La Rocca HP, et al. Validation of the HFA-PEFF score for the diagnosis of heart failure with preserved ejection fraction. Eur J Heart Fail. 2020;22(3):413-21. DOI:10.1002/ejhf.1614

23. Seo M, Yamada T, Tamaki S, et al. Prognostic Significance of Serum Cholinesterase Level in Patients With Acute Decompensated Heart Failure With Preserved Ejection Fraction: Insights From the PURSUIT-HFpEF Registry. J Am Heart Assoc. 2020;9(1):e014100. DOI:10.1161/JAHA.119.014100

24. Iwakura K, Onishi T, Okada M, et al. Validation of the HFA-PEFF- and H2FPEF score in Japanese patients with heart failure with preserved ejection fraction. Eur Heart J. 2020;41(Supplement_2): 2020. DOI:10.1093/ehjci/ehaa946.0998

25. Selvaraj S, Myhre PL, Vaduganathan M, et al. Application of Diagnostic Algorithms for Heart Failure With Preserved Ejection Fraction to the Community. JACC Hear Fail. 2020;8(8):640-53. DOI:10.1016/j.jchf.2020.03.013

26. TOPCAT: FDA Briefing Document Cardiovascular and Renal Drugs Advisory Committee Meeting Spironolactone for Heart Failure with Preserved Ejection Fraction (HFpEF). Published online 2020. [cited by Feb 20, 2021]. Available from: https://www.fda.gov/media/144411/download.

27. FDA Briefing Document Cardiovascular and Renal Drugs Advisory Committee Meeting. Published online 2014:205 [cited by Feb 20, 2021]. Available from: https://www.fda.gov/media/133297/download.

28. Rivas-Lasarte M, Álvarez-García J, Fernández-Martínez J, et al. Lung ultrasound-guided treatment in ambulatory patients with heart failure: a randomized controlled clinical trial (LUS-HF study). Eur J Heart Fail. 2019;21(12):1605-1613. DOI:10.1002/ejhf.1604.

29. Wachter R, Schmidt-Schweda S, Westermann D, et al. Blunted frequency-dependent upregulation of cardiac output is related to impaired relaxation in diastolic heart failure. Eur Heart J. 2009;30(24):3027-3036. DOI:10.1093/eurheartj/ehp341.

30. Borlaug BA, Melenovsky V, Russell SD, et al. Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation. 2006;114(20):2138-47. DOI:10.1161/CIRCULATIONAHA.106.632745.

31. Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71. DOI:10.1016/j.jacc.2013.02.092

32. Borlaug BA, Anstrom KJ, Lewis GD, et al. Effect of Inorganic Nitrite vs Placebo on Exercise Capacity among Patients with Heart Failure with Preserved Ejection Fraction: The INDIE-HFpEF Randomized Clinical Trial. J Am Med Assoc. 2018;320(17):1764-73. DOI:10.1001/jama.2018.14852.

33. Paz-Ares L, de Marinis F, Dediu M, et al. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): A double-blind, phase 3, random. Lancet Oncol. 2012;13(3):247-55. DOI:10.1016/S1470-2045(12)70063-3.

34. Udelson JE, Lewis GD, Shah SJ, et al. Effect of Praliciguat on Peak Rate of Oxygen Consumption in Patients with Heart Failure with Preserved Ejection Fraction: The CAPACITY HFpEF Randomized Clinical Trial. J Am Med Assoc. 2020;324(15):1522-31. DOI:10.1001/jama.2020.16641

35. Armstrong PW, Lam CSP, Anstrom KJ, et al. Effect of Vericiguat vs Placebo on Quality of Life in Patients with Heart Failure and Preserved Ejection Fraction: The VITALITY-HFpEF Randomized Clinical Trial. J Am Med Assoc. 2020;324(15):1512-21. DOI:10.1001/jama.2020.15922.

36. Redfield MM, Chen HH, Borlaug BA, et al. Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: A randomized clinical trial. J Am Med Assoc. 2013;309(12):1268-77. DOI:10.1001/jama.2013.2024.

37. Van Tassell BW, Buckley LF, Carbone S, et al. Interleukin-1 blockade in heart failure with preserved ejection fraction: rationale and design of the Diastolic Heart Failure Anakinra Response Trial 2 (DHART2). Clin Cardiol. 2017;40(9):626-32. DOI:10.1002/clc.22719.

38. Melenovsky V, Hwang SJ, Lin G, et al. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35(48):3452-62. DOI:10.1093/eurheartj/ehu193.

39. Obokata M, Reddy YNV, Melenovsky V, et al. Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction. Eur Heart J. 2019;40(8):689- 98. DOI:10.1093/eurheartj/ehy809.

40. Shah AM, Claggett B, Sweitzer NK, et al. Prognostic Importance of Impaired Systolic Function in Heart Failure with Preserved Ejection Fraction and the Impact of Spironolactone. Circulation. 2015;132(5):402-14. DOI:10.1161/CIRCULATIONAHA.115.015884.

41. Kalra R, Gupta K, Sheets R, et al. Cardiac Function and Sudden Cardiac Death in Heart Failure With Preserved Ejection Fraction (from the TOPCAT Trial). Am J Cardiol. 2020;129:46-52. DOI:10.1016/j.amjcard.2020.04.038.

42. Park JJ, Park CS, Mebazaa A, et al. Characteristics and outcomes of HFpEF with declining ejection fraction. Clin Res Cardiol. 2020;109(2):225-34. DOI:10.1007/s00392-019-01505-y.

43. Shah SJ. 20th Annual Feigenbaum Lecture: Echocardiography for Precision Medicine—Digital Biopsy to Deconstruct Biology. J Am Soc Echocardiogr. 2019;32(11):1379-95.e2. DOI:10.1016/j.echo.2019.08.002.

44. Cohen JB, Schrauben SJ, Zhao L, et al. Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone. JACC Hear Fail. 2020;8(3):172-84. DOI:10.1016/j.jchf.2019.09.009.

45. Shah SJ, Katz DH, Selvaraj S, et al. Phenomapping for novel classification of heart failure with preserved ejection fraction. Circulation. 2015;131(3):269-79. DOI:10.1161/CIRCULATIONAHA.114.010637.

46. Bhatt DL, Szarek M, Steg PG, et al. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. N Engl J Med. 2021;384(2):117-28. DOI:10.1056/nejmoa2030183.