Научно-практический журнал
«Клиническая физиология кровообращения»

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, президент ФГБУ «НМИЦ ССХ им. А.Н. Бакулева» МЗ РФ


Каталог статей ➤ КФК. 2025; 22 (4): 287-382 ➤ Патогенетические механизмы диастолической дисфункции: от общих принципов к индивидуальным фенотипам у пациентов с сердечной недостаточностью с сохранной фракцией выброса

Патогенетические механизмы диастолической дисфункции: от общих принципов к индивидуальным фенотипам у пациентов с сердечной недостаточностью с сохранной фракцией выброса

Авторы: Аверина И.И., Трошин Д.С., Звонарева А.С., Ларионова В.Е., Донаканян C.А.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

DOI: https://doi.org/10.24022/1814-6910-2025-22-4-291-304

УДК: 616.12-008.46-092

Библиографическая ссылка: Клиническая физиология кровообращения. 2025; 22 (4): 291-304

Цитировать как: Аверина И.И., Трошин Д.С., Звонарева А.С., Ларионова В.Е., Донаканян C.А. . Патогенетические механизмы диастолической дисфункции: от общих принципов к индивидуальным фенотипам у пациентов с сердечной недостаточностью с сохранной фракцией выброса. Клиническая физиология кровообращения. 2025; 22 (4): 291-304. DOI: 10.24022/1814-6910-2025-22-4-291-304

Ключевые слова: диастолическая дисфункция, сердечная недостаточность, сохранная фракция выброса, метаболический синдром, низкоинтенсивное воспаление, миопатия, ремоделирование левого предсердия

Поступила / Принята к печати:  11.09.2025 / 30.09.2025

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Аннотация

В последнее время с накоплением информации расширяются наши возможности в понимании патогенеза диастолической дисфункции (ДД) и сердечной недостаточности с сохранной фракцией выброса (СНсФВ) как многокомпонентного процесса, в развитии которого выявлено и много схожего – воспалительные изменения, приводящие к эндотелиальной дисфункции на периферии и в коронарных артериях, и множество различий в фенотипах. При этом существует большая дивергенция в течении различных заболеваний, которые приводят к СНсФВ, – от ишемической болезни сердца, артериальной гипертензии, развития почечной недостаточности до фибрилляции предсердий, увеличения жесткости левого желудочка и миопатии левого предсердия с развитием легочной гипертензии, недостаточности правых отделов сердца. В патогенезе могут быть не один фактор риска или триггер, а множество, действующих совместно в одном направлении, – патогенетическая полимодальность. В последнее время гипотезы развития ДД дополняются новыми исследованиями, которые направлены также на поиск универсальных методов лечения.

Литература

  1. Seferović P., Petrie M., Filippatos G., Anker S., Rosano G., Bauer Sachs J. et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur. J. Heart Fail. 2018; 20 (5): 853-872. DOI: 10.1002/ejhf.1170
  2. Ларина В.Н., Ойноткинова О.Ш., Ларин В.Г., Лунев В.И., Мацкеплишвили С.Т., Гусаренко С.А. Сердечная недостаточность ссохраненной фракцией выброса левого желудочка: комплексный фенотип-ориентированный подход к диагностике и коррекции. Кардиология и сердечно-сосудистая хирургия. 2022; 15 (6): 627–636. DOI: 10.17116/kardio202215061627
  3. Borlaug B.A., Sharma K., Shah S.J., Ho J.E. Heart failure with preserved ejection fraction: JACC Scientific Statement. J. Am. Coll. Cardiol. 2023; 81 (18): 1810–1834. DOI: 10.1016/j.jacc.2023.01.049
  4. Powell-Wiley T., Ngwa J., Kebede S., Lu D., Schulte P., Bhatt D. et al. Impact of body mass index on heart failure by race/ethnicity from the get with the guidelines – heart failure (GWTG – HF) Registry. JACC: Heart Failure. 2018; 6 (3): 233–242. DOI: 10.1016/j.jchf.2017.11.011
  5. Crespo-Leiro M., Anker S., Maggioni A., Coats A., Filippatos G., Ruschitzka F. et al. European Society of Cardiology Heart Failure Long- Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur. J. Heart Fail. 2016; 18 (6): 613–625. DOI: 10.1002/ejhf.566
  6. Хроническая сердечная недостаточность: клинические рекомендации. М.: Минздрав России; 2016.
  7. Фомин И.В. Хроническая сердечная недостаточность в Российской Федерации: что сегодня мы знаем и что должны делать. Российский кардиологический журнал. 2016; 8: 7–13. DOI: 10.15829/1560-4071-2016-8-7-13
  8. Агеев Ф.Т., Овчинников А.Г. Диастолическая сердечная недостаточность: 20 лет спустя. Актуальные вопросы патогенеза, диагностики и лечения сердечной недостаточности с сохраненной ФВ ЛЖ. Кардиология. 2023; 63 (3): 3–12. DOI: 10.18087/cardio.2023.3.n2376
  9. Поляков Д.C., Фомин И.В., Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т., Артемьева Е.Г. и др. Хроническая сердечная недостаточность в Российской Федерации: что изменилось за 20 лет наблюдения? Результаты исследования ЭПОХА–ХСН. Кардиология. 2021; 61 (4): 4–14. DOI: 10.18087/cardio.2021.4.n1628
  10. Zile M.R., Brutsaert D.L. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002; 105 (11): 1387–1393. DOI: 10.1161/hc1102.105289. PMID: 11901053
  11. Kawaguchi M., Hay I., Fetics B., Kass D.A. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation. 2003; 107 (5): 714–720. DOI: 10.1161/01.cir.0000048123.22359.a0. Erratum in: Circulation. 2020; 141 (19): e809. DOI: 10.1161/CIR.0000000000000778
  12. Borlaug B.A., Melenovsky V., Russell S.D., Kessler K., Pacak K., Becker L.C., Kass D.A. Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation. 2006; 114 (20): 2138–2147. DOI: 10.1161/CIRCULATIONAHA.106.632745
  13. Zile M.R., Baicu C.F., Gaasch W.H. Diastolic heart failure – abnormalities in active relaxation and passive stiffness of the left ventricle. N. Engl. J. Med. 2004; 350 (19): 1953–1959. DOI: 10.1056/NEJMoa032566
  14. Borlaug B.A., Sharma K., Shah S.J., Ho J.E. Heart failure with preserved ejection fraction: JACC Scientific Statement. J. Am. Coll. Cardiol. 2023; 81 (18): 1810–1834. DOI: 10.1016/j.jacc.2023.01.049
  15. Verbrugge F.H., Guazzi M., Testani J.M., Borlaug B.A. Altered hemodynamics and end-organ damage in heart failure: impact on the lung and kidney. Circulation. 2020; 142 (10): 998–1012. DOI: 10.1161/CIRCULATIONAHA.119.045409
  16. Lam C.S., Roger V.L., Rodeheffer R.J., Borlaug B.A., Enders F.T., Redfield M.M. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J. Am. Coll. Cardiol. 2009; 53 (13): 1119–1126. DOI: 10.1016/j.jacc.2008.11.051
  17. Omote K., Verbrugge F.H., Sorimachi H., Omar M., Popovic D., Obokata M. et al. Central haemodynamic abnormalities and outcome in patients with unexplained dyspnoea. Eur. J. Heart Fail. 2023; 25 (2): 185–196. DOI: 10.1002/ejhf.2747
  18. Vanderpool R.R., Saul M., Nouraie M., Gladwin M.T., Simon M.A. Association between hemodynamic markers of pulmonary hypertension and outcomes in heart failure with preserved ejection fraction. JAMA Cardiol. 2018; 3 (4): 298–306. DOI: 10.1001/jamacardio.2018.0128. Erratum in: JAMA Cardiol. 2018; 3 (7): 665. DOI: 10.1001/jamacardio.2018.1559
  19. Omote K., Sorimachi H., Obokata M., Reddy Y.N.V., Verbrugge F.H., Omar M. et al. Pulmonary vascular disease in pulmonary hypertension due to left heart disease: pathophysiologic implications. Eur. Heart J. 2022; 43 (36): 3417–3431. DOI: 10.1093/eurheartj/ehac184
  20. Reddy Y.N.V., Obokata M., Verbrugge F.H., Lin G., Borlaug B.A. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation. J. Am. Coll. Cardiol. 2020; 76 (9): 1051–1064. DOI: 10.1016/j.jacc.2020.07.009
  21. Freed B.H., Daruwalla V., Cheng J.Y., Aguilar F.G., Beussink L., Choi A. et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ. Cardiovasc. I maging. 2016; 9 (3): e003754. DOI: 10.1161/CIRCIMAGING.115.003754
  22. Ferrari R., Balla C., Fucili A. Heart failure: an historical perspective. Eur. Heart J. 2016; 18 (Suppl. G): G3–G101. DOI: 10.1093/eurheartj/suw042
  23. Borlaug B.A., Jensen M.D., Kitzman D.W., Lam C.S.P., Obokata M., Rider O.J. Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets. Cardiovasc. Res. 2022; 118 (18): 3434–3450. DOI: 10.1093/cvr/cvac120
  24. Ng A.C.T., Delgado V., Borlaug B.A. et al. Diabesity: the combined burden of obesity and diabetes on heart disease and the role of imaging. Nat. Rev. Cardiol. 2021; 18 (4): 291–304. DOI: 10.1038/s41569-020-00465-5
  25. Paulus W.J., 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): 263–271. DOI: 10.1016/j.jacc.2013.02.092
  26. Schiattarella G.G., Rodolico D., Hill J.A. Metabolic inflammation in heart failure with preserved ejection fraction. Cardiovasc. Res. 2021; 117(2): 423–434. DOI: 10.1093/cvr/cvaa217
  27. Pandey A., Shah S.J., Butler J., Kellogg D.L. Jr, Lewis G.D., Forman D.E. et al. Exercise intolerance in older adults with heart failure with preserved ejection fraction: JACC State-of-the-Art Review. J. Am. Coll. Cardiol. 2021; 78 (11): 1166–1187. DOI: 10.1016/j.jacc.2021.07.014
  28. Paulus W.J., Zile M.R. From systemic inflammation to myocardial fibrosis: the heart failure with preserved ejection fraction paradigm revisited. Circ. Res. 2021; 128 (10): 1451–1467. DOI: 10.1161/CIRCRESAHA.121.318159
  29. Hahn V.S., Yanek L.R., Vaishnav J., Ying W., Vaidya D., Lee Y.Z.J. et al. Endomyocardial biopsy characterization of heart failure with preserved ejection fraction and prevalence of cardiac amyloidosis. JACC Heart Fail. 2020; 8 (9): 712–724. DOI: 10.1016/j.jchf.2020.04.007
  30. Chung C.S., Hutchinson K.R., Methawasin M., Saripalli C., Smith J.E. 3rd, Hidalgo C.G. et al. Shortening of the elastic tandem immunoglobulin segment of titin leads to diastolic dysfunction. Circulation. 2013; 128 (1): 19–28. DOI: 10.1161/CIRCULATIONAHA.112.001268
  31. LeWinter M.M., Granzier H.L. Cardiac titin and heart disease. J. Cardiovasc. Pharmacol. 2014; 63 (3): 207–212. DOI: 10.1097/FJC.0000000000000007
  32. Linke W.A., Hamdani N. Gigantic business: titin properties and function through thick and thin. Circ. Res. 2014; 114 (6): 1052–1068. DOI: 10.1161/CIRCRESAHA.114.301286
  33. Haass M., Kitzman D.W., Anand I.S., Miller A., Zile M.R., Massie B.M., Carson P.E. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction: results from the Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial. Circ. Heart Fail. 2011; 4: 324–331. DOI: 10.1161/CIRCHEARTFAILURE.110.959890
  34. Obokata M., Reddy Y.N.V., Pislaru S.V., Melenovsky V., Borlaug B.A. Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction. Circulation. 2017; 136 (1): 6–19. DOI: 10.1161/CIRCULATIONAHA.116.026807
  35. Borlaug B.A., Reddy Y.N.V. The Role of the pericardium in heart failure: implications for pathophysiology and treatment. JACC Heart Fail. 2019; 7 (7): 574–585. DOI: 10.1016/j.jchf.2019.03.021
  36. Wohlfahrt P., Redfield M.M., Lopez-Jimenez F., Melenovsky V., Kane G.C., Rodeheffer R.J., Borlaug B.A. Impact of general and central adiposity on ventricular-arterial aging in women and men. JACC Heart Fail. 2014; 2 (5): 489–499. DOI: 10.1016/j.jchf.2014.03.014
  37. Miller W.L., Borlaug B.A. Impact of obesity on volume status in patients with ambulatory chronic heart failure. J. Card. Fail. 2020; 26 (2): 112–117. DOI: 10.1016/j.cardfail.2019.09.010
  38. Sorimachi H., Burkhoff D., Verbrugge F.H., Omote K., Obokata M., Reddy Y.N.V. et al. Obesity, venous capacitance, and venous compliance in heart failure with preserved ejection fraction. Eur. J. Heart Fail. 2021; 23 (10): 1648–1658. DOI: 10.1002/ejhf.2254
  39. Aslam M.I., Hahn V.S., Jani V., Hsu S., Sharma K., Kass D.A. Reduced right ventricular sarcomere contractility in heart failure with preserved ejection fraction and severe obesity. Circulation. 2021; 143 (9): 965–967. DOI: 10.1161/CIRCULATIONAHA.120.052414
  40. Hahn V.S., Knutsdottir H., Luo X., Bedi K., Margulies K.B., Haldar S.M. et al. Myocardial gene expression signatures in human heart failure with preserved ejection fraction. Circulation. 2021; 143 (2): 120–134. DOI: 10.1161/CIRCULATIONAHA.120.050498. Erratum in: Circulation. 2021; 143 (23): e1027. DOI: 10.1161/CIR.0000000000000990
  41. Koepp K.E., Obokata M., Reddy Y.N.V., Olson T.P., Borlaug B.A. Hemodynamic and functional impact of epicardial adipose tissue in heart failure with preserved ejection faction. JACC Heart Fail. 2020; 8 (8): 657–666. DOI: 10.1016/j.jchf.2020.04.016
  42. Melenovsky V., Hwang S.J., Lin G., Redfield M.M., Borlaug B.A. Right heart dysfunction in heart failure with preserved ejection fraction. Eur. Heart J. 2014; 35 (48): 3452–3462. DOI: 10.1093/eurheartj/ehu193
  43. Obokata M., Reddy Y.N.V., Melenovsky V., Pislaru S., Borlaug B.A. Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction. Eur. Heart J. 2019; 40 (8): 689–697. DOI: 10.1093/eurheartj/ehy809
  44. Reddy Y.N.V., Kaye D.M., Handoko M.L., van de Bovenkamp A.A., Tedford R.J., Keck C. et al. Diagnosis of heart failure with preserved ejection fraction among patients with unexplained dyspnea. JAMA Cardiol. 2022; 7 (9): 891–899. DOI: 10.1001/jamacardio.2022.1916
  45. Sanders-van Wijk S., Tromp J., Beussink-Nelson L., Hage C., Svedlund S., Saraste A. et al. Proteomic evaluation of the comorbidity- inflammation paradigm in heart failure with preserved ejection fraction: results from the PROMIS-HFpEF Study. Circulation. 2020; 142 (21): 2029–2044. DOI: 10.1161/CIRCULATIONAHA.120.045810
  46. Franssen C., Chen S., Unger A., Korkmaz H.I., De Keulenaer G.W., Tschöpe C. et al. Myocardial microvascular inflammatory endothelial activation in heart failure with preserved ejection fraction. JACC Heart Fail. 2016; 4: 312–314. DOI: 10.1016/j.jchf.2015.10.007
  47. Packer M. Critical reanalysis of the mechanisms underlying the cardiorenal benefits of SGLT2 inhibitors and reaffirmation of the nutrient deprivation signaling/autophagy hypothesis. Circulation. 2022; 146 (18): 1383–1405. DOI: 10.1161/CIRCULATIONAHA.122.061732
  48. Shah S.J., Lam C.S.P., Svedlund S., Saraste A., Hage C., Tan R.S. et al. Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF. Eur. Heart J. 2018; 39 (37): 3439–3450. DOI: 10.1093/eurheartj/ehy531. Erratum in: Eur Heart J. 2019; 40 (6): 541. DOI: 10.1093/eurheartj/ehy804
  49. González A., Richards A.M., de Boer R.A., Thum T., Arfsten H., Hülsmann M. et al. Cardiac remodelling – Part 1: From cells and tissues to circulating biomarkers. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology. Erratum in: Eur. J. Heart Fail. 2024; 26 (1): 193. DOI: 10.1002/ejhf.3123
  50. Zannad F., Ferreira J.P., Butler J., Filippatos G., Januzzi J.L., Sumin M. et al. Effect of empagliflozin on circulating proteomics in heart failure: mechanistic insights into the EMPEROR programme. Eur Heart J. 2022; 43 (48): 4991–5002. DOI: 10.1093/eurheartj/ehac495
  51. Sarma S., Stoller D., Hendrix J., Howden E., Lawley J., Livingston S. et al. Mechanisms of Chronotropic Incompetence in Heart Failure With Preserved Ejection Fraction. Circ. Heart Fail. 2020; 13 (3): e006331. DOI: 10.1161/CIRCHEARTFAILURE.119.006331
  52. Triposkiadis F., Butler J., Abboud F.M., Armstrong P.W., Adamopoulos S., Atherton J.J. et al. The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur. Heart J. 2019; 40 (26): 2155–2163. DOI: 10.1093/eurheartj/ehz158
  53. Голухова Е.З., Булаева Н.И., Александрова С.А., Бердибеков Б.Ш. Влияние катетерной изоляции устьев легочных вен на прогноз пациентов с фибрилляцией предсердий и хронической сердечной недостаточностью со сниженной фракцией выброса: обновленный систематический обзор и метаанализ. Российский кардиологический журнал. 2024; 29 (2S): 5796. DOI: 10.15829/1560-4071-2024-5796
  54. Тарасова К.А., Бердибеков Б.Ш., Булаева Н.И., Голухова Е.З. Влияние катетерной изоляции устьев легочных вен на прогноз пациентов с фибрилляцией предсердий и хронической сердечной недостаточностью с сохраненной фракцией выброса. Креативная кардиология. 2023; 17 (3): 359–366. DOI: 10.24022/1997-3187-2023-17-3-359-366
  55. Anker S.D., Butler J., Filippatos G., Ferreira J.P., Bocchi E., Böhm M. Empagliflozin in heart failure with a preserved ejection fraction. N. Engl.J. Med. 2021; 385 (16): 145161. DOI: 10.1056/NEJMoa2107038
  56. Shah S.J., Borlaug B.A., Kitzman D.W., McCulloch A.D., Blaxall B.C., Agarwal R. et al. Research priorities for heart failure with preserved ejection fraction: National Heart, Lung, and Blood Institute Working Group Summary. Circulation. 2020; 141 (12): 1001–1026. DOI: 10.1161/CIRCULATIONAHA.119.041886
  57. Sorimachi H., Omote K., Borlaug B.A. Clinical phenogroups in heart failure with preserved ejection fraction. Heart Fail. Clin. 2021; 17 (3): 483–498. DOI: 10.1016/j.hfc.2021.02.009
  58. Голухова Е.З., Александрова С.А., Бердибеков Б.Ш. Прогностическая роль количественной оценки миокардиального фиброза по данным магнитно-резонансной томографии с отсроченным контрастированием при неишемических дилатационных кардиомиопатиях: систематический обзор и метаанализ. Российский кардиологический журнал. 2021; 26 (12): 4776. DOI: 10.15829/1560-4071-2021-4776
  59. Бердибеков Б.Ш., Александрова С.А., Булаева Н.И., Голухова Е.З. Магнитно-резонансная томография сердца для прогнозирования обратного ремоделирования левого желудочка при дилатационной кардиомиопатии: метаанализ. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2025; 26 (S3): 110.
  60. Демченко Е.А., Голухова Е.З., Сливнева И.В., Петросян К.В., Пирушкина Ю.Д. Влияние фенотипических и гемодинамических особенностей левого желудочка на непосредственные результаты хирургического лечения тяжелого аортального стеноза. Сердечно- сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2025; 26 (S3).
  61. Демченко Е.А., Сливнева И.В., Пирушкина Ю.Д., Голухова Е.З. Временные аспекты кластеризации пациентов с тяжелым аортальным стенозом. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2024; 25 (S3).
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  1. Seferović P., Petrie M., Filippatos G., Anker S., Rosano G., Bauer Sachs J. et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur. J. Heart Fail. 2018; 20 (5): 853-872. DOI: 10.1002/ejhf.1170
  2. Larina V.N., Oynotkinova O.Sh., Larin V.G., Lunev V.I., Matskeplishvili S.T., Gusarenko S.A. Heart failure with preserved left ventricular ejection fraction: a comprehensive phenotype-based approach to diagnosis and treatment. Russian Journal of Cardiology and Cardiovascular Surgery. 2022; 15 (6): 627–636 (in Russ.). DOI: 10.17116/kardio202215061627
  3. Borlaug B.A., Sharma K., Shah S.J., Ho J.E. Heart failure with preserved ejection fraction: JACC Scientific Statement. J. Am. Coll. Cardiol. 2023; 81 (18): 1810–1834. DOI: 10.1016/j.jacc.2023.01.049
  4. Powell-Wiley T., Ngwa J., Kebede S., Lu D., Schulte P., Bhatt D. et al. Impact of body mass index on heart failure by race/ethnicity from the get with the guidelines – heart failure (GWTG – HF) Registry. JACC: Heart Failure. 2018; 6 (3): 233–242. DOI: 10.1016/j.jchf.2017.11.011
  5. Crespo-Leiro M., Anker S., Maggioni A., Coats A., Filippatos G., Ruschitzka F. et al. European Society of Cardiology Heart Failure Long- Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur. J. Heart Fail. 2016; 18 (6): 613–625. DOI: 10.1002/ejhf.566
  6. Chronic heart failure: сlinical guidelines. Moscow: Ministry of Health of the Russian Federation; 2016 (in Russ.).
  7. Fomin I.V. Chronic heart failure in russian federation: what do we know and what to do. Russian Journal of Cardiology. 2016; 8: 7–13 (in Russ.). DOI: 10.15829/1560-4071-2016-8-7-13
  8. Ageev F.T., Ovchinnikov A.G. Diastolic heart failure: 20 years later. Сurrent issues of pathogenesis, diagnosis and treatment of heart failure with preserved LVEF. Kardiologiia. 2023; 63 (3): 3–12 (in Russ.). DOI: 10.18087/cardio.2023.3.n2376
  9. Polyakov D.S., Fomin I.V., Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Artemieva E.G. et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of observation? Results of the EPOCHA-CHF study. Kardiologiia. 2021; 61 (4): 4–14 (in Russ.). DOI: 10.18087/cardio.2021.4.n1628
  10. Zile M.R., Brutsaert D.L. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002; 105 (11): 1387–1393. DOI: 10.1161/hc1102.105289. PMID: 11901053
  11. Kawaguchi M., Hay I., Fetics B., Kass D.A. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation. 2003; 107 (5): 714–720. DOI: 10.1161/01.cir.0000048123.22359.a0. Erratum in: Circulation. 2020; 141 (19): e809. DOI: 10.1161/CIR.0000000000000778
  12. Borlaug B.A., Melenovsky V., Russell S.D., Kessler K., Pacak K., Becker L.C., Kass D.A. Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation. 2006; 114 (20): 2138–2147. DOI: 10.1161/CIRCULATIONAHA.106.632745
  13. Zile M.R., Baicu C.F., Gaasch W.H. Diastolic heart failure – abnormalities in active relaxation and passive stiffness of the left ventricle. N. Engl. J. Med. 2004; 350 (19): 1953–1959. DOI: 10.1056/NEJMoa032566
  14. Borlaug B.A., Sharma K., Shah S.J., Ho J.E. Heart failure with preserved ejection fraction: JACC Scientific Statement. J. Am. Coll. Cardiol. 2023; 81 (18): 1810–1834. DOI: 10.1016/j.jacc.2023.01.049
  15. Verbrugge F.H., Guazzi M., Testani J.M., Borlaug B.A. Altered hemodynamics and end-organ damage in heart failure: impact on the lung and kidney. Circulation. 2020; 142 (10): 998–1012. DOI: 10.1161/CIRCULATIONAHA.119.045409
  16. Lam C.S., Roger V.L., Rodeheffer R.J., Borlaug B.A., Enders F.T., Redfield M.M. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J. Am. Coll. Cardiol. 2009; 53 (13): 1119–1126. DOI: 10.1016/j.jacc.2008.11.051
  17. Omote K., Verbrugge F.H., Sorimachi H., Omar M., Popovic D., Obokata M. et al. Central haemodynamic abnormalities and outcome in patients with unexplained dyspnoea. Eur. J. Heart Fail. 2023; 25 (2): 185–196. DOI: 10.1002/ejhf.2747
  18. Vanderpool R.R., Saul M., Nouraie M., Gladwin M.T., Simon M.A. Association between hemodynamic markers of pulmonary hypertension and outcomes in heart failure with preserved ejection fraction. JAMA Cardiol. 2018; 3 (4): 298–306. DOI: 10.1001/jamacardio.2018.0128. Erratum in: JAMA Cardiol. 2018; 3 (7): 665. DOI: 10.1001/jamacardio.2018.1559
  19. Omote K., Sorimachi H., Obokata M., Reddy Y.N.V., Verbrugge F.H., Omar M. et al. Pulmonary vascular disease in pulmonary hypertension due to left heart disease: pathophysiologic implications. Eur. Heart J. 2022; 43 (36): 3417–3431. DOI: 10.1093/eurheartj/ehac184
  20. Reddy Y.N.V., Obokata M., Verbrugge F.H., Lin G., Borlaug B.A. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation. J. Am. Coll. Cardiol. 2020; 76 (9): 1051–1064. DOI: 10.1016/j.jacc.2020.07.009
  21. Freed B.H., Daruwalla V., Cheng J.Y., Aguilar F.G., Beussink L., Choi A. et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ. Cardiovasc. Imaging. 2016; 9 (3): e003754. DOI: 10.1161/CIRCIMAGING.115.003754
  22. Ferrari R., Balla C., Fucili A. Heart failure: an historical perspective. Eur. Heart J. 2016; 18 (Suppl. G): G3–G101. DOI: 10.1093/eurheartj/suw042
  23. Borlaug B.A., Jensen M.D., Kitzman D.W., Lam C.S.P., Obokata M., Rider O.J. Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets. Cardiovasc. Res. 2022; 118 (18): 3434–3450. DOI: 10.1093/cvr/cvac120
  24. Ng A.C.T., Delgado V., Borlaug B.A. et al. Diabesity: the combined burden of obesity and diabetes on heart disease and the role of imaging. Nat. Rev. Cardiol. 2021; 18 (4): 291–304. DOI: 10.1038/s41569-020-00465-5
  25. Paulus W.J., 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): 263–271. DOI: 10.1016/j.jacc.2013.02.092
  26. Schiattarella G.G., Rodolico D., Hill J.A. Metabolic inflammation in heart failure with preserved ejection fraction. Cardiovasc. Res. 2021; 117(2): 423–434. DOI: 10.1093/cvr/cvaa217
  27. Pandey A., Shah S.J., Butler J., Kellogg D.L. Jr, Lewis G.D., Forman D.E. et al. Exercise intolerance in older adults with heart failure with preserved ejection fraction: JACC State-of-the-Art Review. J. Am. Coll. Cardiol. 2021; 78 (11): 1166–1187. DOI: 10.1016/j.jacc.2021.07.014
  28. Paulus W.J., Zile M.R. From systemic inflammation to myocardial fibrosis: the heart failure with preserved ejection fraction paradigm revisited. Circ. Res. 2021; 128 (10): 1451–1467. DOI: 10.1161/CIRCRESAHA.121.318159
  29. Hahn V.S., Yanek L.R., Vaishnav J., Ying W., Vaidya D., Lee Y.Z.J. et al. Endomyocardial biopsy characterization of heart failure with preserved ejection fraction and prevalence of cardiac amyloidosis. JACC Heart Fail. 2020; 8 (9): 712–724. DOI: 10.1016/j.jchf.2020.04.007
  30. Chung C.S., Hutchinson K.R., Methawasin M., Saripalli C., Smith J.E. 3rd, Hidalgo C.G. et al. Shortening of the elastic tandem immunoglobulin segment of titin leads to diastolic dysfunction. Circulation. 2013; 128 (1): 19–28. DOI: 10.1161/CIRCULATIONAHA.112.001268
  31. LeWinter M.M., Granzier H.L. Cardiac titin and heart disease. J. Cardiovasc. Pharmacol. 2014; 63 (3): 207–212. DOI: 10.1097/FJC.0000000000000007
  32. Linke W.A., Hamdani N. Gigantic business: titin properties and function through thick and thin. Circ. Res. 2014; 114 (6): 1052–1068. DOI: 10.1161/CIRCRESAHA.114.301286
  33. Haass M., Kitzman D.W. D.W., Anand I.S., Miller A., Zile M.R., Massie B.M., Carson P.E. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction: results from the Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial. Circ. Heart Fail. 2011; 4: 324–331. DOI: 10.1161/CIRCHEARTFAILURE.110.959890
  34. Obokata M., Reddy Y.N.V., Pislaru S.V., Melenovsky V., Borlaug B.A. Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction. Circulation. 2017; 136 (1): 6–19. DOI: 10.1161/CIRCULATIONAHA.116.026807
  35. Borlaug B.A., Reddy Y.N.V. The Role of the pericardium in heart failure: implications for pathophysiology and treatment. JACC Heart Fail. 2019; 7 (7): 574–585. DOI: 10.1016/j.jchf.2019.03.021
    36. ChatGPT | Nano Banana, [24.03.2026 18:51] echanisms underlying the cardiorenal benefits of SGLT2 inhibitors and reaffirmation of the nutrient deprivation signaling/autophagy hypothesis. Circulation. 2022; 146 (18): 1383–1405. DOI: 10.1161/CIRCULATIONAHA.122.061732
  36. Shah S.J., Lam C.S.P., Svedlund S., Saraste A., Hage C., Tan R.S. et al. Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF. Eur. Heart J. 2018; 39 (37): 3439–3450. DOI: 10.1093/eurheartj/ehy531. Erratum in: Eur Heart J. 2019; 40 (6): 541. DOI: 10.1093/eurheartj/ehy804
  1. Wohlfahrt P., Redfield M.M., Lopez-Jimenez F., Melenovsky V., Kane G.C., Rodeheffer R.J., Borlaug B.A. Impact of general and central adiposity on ventricular-arterial aging in women and men. JACC Heart Fail. 2014; 2 (5): 489–499. DOI: 10.1016/j.jchf.2014.03.014
  2. Miller W.L., Borlaug B.A. Impact of obesity on volume status in patients with ambulatory chronic heart failure. J. Card. Fail. 2020; 26 (2): 112–117. DOI: 10.1016/j.cardfail.2019.09.010
  3. Sorimachi H., Burkhoff D., Verbrugge F.H., Omote K., Obokata M., Reddy Y.N.V. et al. Obesity, venous capacitance, and venous compliance in heart failure with preserved ejection fraction. Eur. J. Heart Fail. 2021; 23 (10): 1648–1658. DOI: 10.1002/ejhf.2254
  4. Aslam M.I., Hahn V.S., Jani V., Hsu S., Sharma K., Kass D.A. Reduced right ventricular sarcomere contractility in heart failure with preserved ejection fraction and severe obesity. Circulation. 2021; 143 (9): 965–967. DOI: 10.1161/CIRCULATIONAHA.120.052414
  5. Hahn V.S., Knutsdottir H., Luo X., Bedi K., Margulies K.B., Haldar S.M. et al. Myocardial gene expression signatures in human heart failure with preserved ejection fraction. Circulation. 2021; 143 (2): 120–134. DOI: 10.1161/CIRCULATIONAHA.120.050498. Erratum in: Circulation. 2021; 143 (23): e1027. DOI: 10.1161/CIR.0000000000000990
  6. Koepp K.E., Obokata M., Reddy Y.N.V., Olson T.P., Borlaug B.A. Hemodynamic and functional impact of epicardial adipose tissue in heart failure with preserved ejection faction. JACC Heart Fail. 2020; 8 (8): 657–666. DOI: 10.1016/j.jchf.2020.04.016
  7. Melenovsky V., Hwang S.J., Lin G., Redfield M.M., Borlaug B.A. Right heart dysfunction in heart failure with preserved ejection fraction. Eur. Heart J. 2014; 35 (48): 3452–3462. DOI: 10.1093/eurheartj/ehu193
  8. Obokata M., Reddy Y.N.V., Melenovsky V., Pislaru S., Borlaug B.A. Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction. Eur. Heart J. 2019; 40 (8): 689–697. DOI: 10.1093/eurheartj/ehy809
  9. Reddy Y.N.V., Kaye D.M., Handoko M.L., van de Bovenkamp A.A., Tedford R.J., Keck C. et al. Diagnosis of heart failure with preserved ejection fraction among patients with unexplained dyspnea. JAMA Cardiol. 2022; 7 (9): 891–899. DOI: 10.1001/jamacardio.2022.1916
  10. Sanders-van Wijk S., Tromp J., Beussink-Nelson L., Hage C., Svedlund S., Saraste A. et al. Proteomic evaluation of the comorbidity- inflammation paradigm in heart failure with preserved ejection fraction: results from the PROMIS-HFpEF Study. Circulation. 2020; 142 (21): 2029–2044. DOI: 10.1161/CIRCULATIONAHA.120.045810
  11. Franssen C., Chen S., Unger A., Korkmaz H.I., De Keulenaer G.W., Tschöpe C. et al. Myocardial microvascular inflammatory endothelial activation in heart failure with preserved ejection fraction. JACC Heart Fail. 2016; 4: 312–314. DOI: 10.1016/j.jchf.2015.10.007
  12. Packer M. Critical reanalysis of the mechanisms underlying the cardiorenal benefits of SGLT2 inhibitors and reaffirmation of the nutrient deprivation signaling/autophagy hypothesis. Circulation. 2022; 146 (18): 1383–1405. DOI: 10.1161/CIRCULATIONAHA.122.061732
  13. Shah S.J., Lam C.S.P., Svedlund S., Saraste A., Hage C., Tan R.S. et al. Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF. Eur. Heart J. 2018; 39 (37): 3439–3450. DOI: 10.1093/eurheartj/ehy531. Erratum in: Eur Heart J. 2019; 40 (6): 541. DOI: 10.1093/eurheartj/ehy804
  14. González A., Richards A.M., de Boer R.A., Thum T., Arfsten H., Hülsmann M. et al. Cardiac remodelling – Part 1: From cells and tissues to circulating biomarkers. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology. Erratum in: Eur. J. Heart Fail. 2024; 26 (1): 193. DOI: 10.1002/ejhf.3123
  15. Zannad F., Ferreira J.P., Butler J., Filippatos G., Januzzi J.L., Sumin M. et al. Effect of empagliflozin on circulating proteomics in heart failure: mechanistic insights into the EMPEROR programme. Eur Heart J. 2022; 43 (48): 4991–5002. DOI: 10.1093/eurheartj/ehac495
  16. Sarma S., Stoller D., Hendrix J., Howden E., Lawley J., Livingston S. et al. Mechanisms of Chronotropic Incompetence in Heart Failure With Preserved Ejection Fraction. Circ. Heart Fail. 2020; 13 (3): e006331. DOI: 10.1161/CIRCHEARTFAILURE.119.006331
  17. Triposkiadis F., Butler J., Abboud F.M., Armstrong P.W., Adamopoulos S., Atherton J.J. et al. The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur. Heart J. 2019; 40 (26): 2155–2163. DOI: 10.1093/eurheartj/ehz158
  18. Golukhova E.Z., Bulaeva N.I., Alexandrova S.A., Berdibekov B.Sh. Impact of pulmonary vein isolation on the prognosis of patients with atrial fibrillation and heart failure with reduced ejection fraction: an updated systematic review and meta-analysis. Russian Journal of Cardiology. 2024; 29 (2S): 5796 (in Russ.). DOI: 10.15829/1560-4071-2024-5796
  19. Tarasova K.A., Berdibekov B.Sh., Bulaeva N.I., Golukhova E.Z. Prognostic role of pulmonary vein isolation in patients with atrial fibrillation and heart failure with preserved ejection fraction. Creative Cardiology. 2023; 17 (3): 359–66 (in Russ.). DOI: 10.24022/1997-3187-2023-17-3-359-366
  20. Anker S.D., Butler J., Filippatos G., Ferreira J.P., Bocchi E., Böhm M. Empagliflozin in heart failure with a preserved ejection fraction. N. Engl.J. Med. 2021; 385 (16): 145161. DOI: 10.1056/NEJMoa2107038
  21. Shah S.J., Borlaug B.A., Kitzman D.W., McCulloch A.D., Blaxall B.C., Agarwal R. et al. Research priorities for heart failure with preserved ejection fraction: National Heart, Lung, and Blood Institute Working Group Summary. Circulation. 2020; 141 (12): 1001–1026. DOI: 10.1161/CIRCULATIONAHA.119.041886
  22. Sorimachi H., Omote K., Borlaug B.A. Clinical phenogroups in heart failure with preserved ejection fraction. Heart Fail. Clin. 2021; 17 (3): 483–498. DOI: 10.1016/j.hfc.2021.02.009
  23. Golukhova E.Z., Aleksandrova S.A., Berdibekov B.Sh. Predictive role of quantification of myocardial fibrosis using delayed contrast- enhanced magnetic resonance imaging in nonischemic dilated cardiomyopathies: a systematic review and meta-analysis. Russian Journal of Cardiology. 2021; 26 (12): 4776 (in Russ.). DOI: 10.15829/1560-4071-2021-4776
  24. Berdibekov B.Sh., Alexandrova S.A., Bulaeva N.I., Golukhova E.Z. Magnetic resonance imaging of the heart for predicting reverse remodeling of the left ventricle in dilated cardiomyopathy: a meta-analysis. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2025; 26 (S3): 110 (in Russ.).
  25. Demchenko E.A., Golukhova E.Z., Slivneva I.V., Petrosyan K.V., Pirushkina Yu.D. Influence of phenotypic and hemodynamic features of the left ventricle on the immediate results of surgical treatment of severe aortic stenosis. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2025; 26 (S3) (in Russ.).
  26. Demchenko E.A., Slivneva I.V., Pirushkina Yu.D., Golukhova E.Z. Temporal aspects of clusterization of patients with severe aortic stenosis. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2024; 25 (S3) (in Russ.).

Об авторах

  • Аверина Ирина Ивановна, д-р мед. наук, ст. науч. сотр., кардиолог; ORCID
  • Трошин Дмитрий Сергеевич, аспирант, кардиолог; ORCID
  • Звонарева Анна Сергеевна, кардиолог; ORCID
  • Ларионова Виктория Евгеньевна, клинический ординатор; ORCID
  • Донаканян Сергей Агванович, д-р мед. наук, профессор, заведующий отделением хирургического лечения интерактивной патологии; ORCID

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