Phenotyping heart failure represents a major challenge for both research studies and clinical practice. Large-scale clinical trials have failed to achieve meaningful improvement in clinical outcomes with different pharmacological agents in patients with heart failure and preserved left ventricular ejection fraction. Therefore, an alternative scheme for phenotyping heart failure is needed, which is both pathophysiologically distinct and practical for routine clinical application. Heart failure is a syndromic diagnosis broadly based on clinical features, physical findings, and serum biomarkers. Although the assessment of exercise hemodynamics and invasive estimation of filling pressures may be necessary, it is typically confirmed and phenotyped by the imaging data. Phenotyping heart failure represents a major challenge despite decades of ongoing research, vast clinical experience in the field, and multiple iterations of published guidelines. Left ventricular ejection fraction (LVEF) remains the major phenotyping tool endorsed by multiple cardiology societies. However, it has multiple limitations especially in patients with heart failure with preserved LVEF (HFpEF), and many have questioned the current approach to phenotyping of heart failure but no alternative, widely accepted, scheme (which is both clinically relevant and practical) has been offered.1 The existing phenotyping approach to heart failure is based on the premise of LVEF as a surrogate marker for left ventricular systolic performance and, in turn, prognosis. Heart failure patients with reduced LVEF (HFrEF) are assumed to have systolic heart failure, whereas many heart failure patients have preservation of LVEF and are commonly labeled as HFpEF. This assumption makes LVEF the primary marker of heart failure and excludes other important abnormalities that can create the heart failure syndrome. Furthermore, LVEF is an imperfect marker even for assessment of systolic function: it has high interobserver variability, it mainly reflects radial shortening, it is load dependent, and it does not reflect the remodeling pattern of the …

中文翻译：

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保留射血分数表型和超声心动图成像缓解心力衰竭

表型心力衰竭是研究和临床实践的主要挑战。大型临床试验未能在不同的药物治疗心力衰竭和保留左心室射血分数的患者中取得有意义的临床效果改善。因此，需要用于心力衰竭表型的替代方案，该方案在病理生理学上是不同的，并且对于常规临床应用而言是实用的。心力衰竭是一种综合症状诊断，广泛地基于临床特征，体格检查结果和血清生物标志物。尽管可能需要评估运动血流动力学和侵入性估计充盈压，但通常可以通过成像数据对其进行确认并表型化。尽管数十年的持续研究，该领域的丰富临床经验以及已发布指南的多次迭代，表型心力衰竭仍然是一项重大挑战。左心室射血分数（LVEF）仍然是多个心脏病学会认可的主要表型分析工具。然而，它有多个局限性，特别是对于LVEF保留（HFpEF）的心力衰竭患者，许多人质疑目前心力衰竭表型的方法，但尚无替代方案被广泛接受（在临床上相关且实用） 1现有的心力衰竭表型研究方法是基于LVEF的前提，LVEF是左心室收缩表现以及预后的替代指标。LVEF（HFrEF）降低的心力衰竭患者被认为患有收缩性心力衰竭，而许多心力衰竭患者具有LVEF保留，通常被标记为HFpEF。该假设使LVEF成为心力衰竭的主要标志，并排除了可能导致心力衰竭综合征的其他重要异常。此外，LVEF甚至在评估收缩功能方面也不是一个完美的标记：它具有较高的观察者间变异性，主要反映了径向缩短，它与负荷有关，并且不反映…的重塑模式。