The harbinger of mortality in heart failure with preserved ejection fraction: Do GDF-15 levels reflect tandem, deterministic effects of fibrosis and inflammation?

摘要

Heart failure (HF) continues to have a significant clinical burden with a high rate of mortality and morbidity. The European Society of Cardiology and the American Heart Association guidelines on HF classify ambulatory patients with chronic HF based on left ventricular ejection fraction (LVEF) into HF with preserved (LVEF > 50%) or reduced (LVEF < 50%) LVEF, HFPEF or HFREF, respectively. Presently, HFPEF accounts for approximately 40% of HF diagnoses, with an increasing incidence, and mortality and morbidity comparable with HFREF. These distinct groups of patients represent a phenotypic variation along the continuum of the HF syndrome. Unlike the situation in patients with HFREF, clinical trials with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, (3-adrenergic receptor antagonists (beta-blockers), mineralocorticoid receptor antagonists, and phosphodiesterase-5 inhibitors have failed to show any consistent and significant improvement in the clinical outcomes of patients with HFPEF.