The heart failure (HF) epidemic is growing and approximately half of the HF patients have heart failure with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous syndrome, characterized by a preserved left ventricular ejection fraction (LVEF ≥ 50%) with diastolic dysfunction, and is associated with high morbidity and mortality. Underlying comorbidities of HFpEF, i.e., hypertension, type 2 diabetes mellitus, obesity, and renal failure, lead to a systemic pro-inflammatory state, thereby affecting normal cardiac function. Increased inflammatory biomarkers predict incident HFpEF and are higher in patients with HFpEF as compared with heart failure with reduced ejection fraction (HFrEF). Randomized trials in HFpEF patients using traditional HF medication failed to demonstrate a clear benefit on hard endpoints (mortality and/or HF hospitalization). Therefore, therapies targeting underlying comorbidities and systemic inflammation in early HFpEF may provide better opportunities. Here, we provide an overview of the current state and future perspectives of immunomodulatory therapies for HFpEF.

中文翻译：

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保留射血分数的心力衰竭的免疫调节：现状和未来展望。

心力衰竭（HF）的流行正在加剧，大约一半的心力衰竭患者患有射血分数保留的心力衰竭（HFpEF）。HFpEF 是一种异质性综合征，其特征是左心室射血分数保留 (LVEF ≥ 50%) 并伴有舒张功能障碍，并且与高发病率和死亡率相关。HFpEF 的潜在合并症，即高血压、2 型糖尿病、肥胖和肾功能衰竭，会导致全身促炎症状态，从而影响正常的心脏功能。炎症生物标志物的增加可预测 HFpEF 的发生，并且与射血分数降低的心力衰竭 (HFrEF) 患者相比，HFpEF 患者的炎症生物标志物含量更高。使用传统心力衰竭药物对 HFpEF 患者进行的随机试验未能证明对硬终点（死亡率和/或心力衰竭住院治疗）有明显的益处。因此，针对早期 HFpEF 潜在合并症和全身炎症的治疗可能提供更好的机会。在这里，我们概述了 HFpEF 免疫调节疗法的现状和未来前景。