2017-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/649717摘要：舒張性心臟衰竭(heart failure with preserved left ventricular ejection fraction, HFpEF)在臨床上越來越受重視，不僅因為HFpEF 的發生率隨著人口的老化而增加，還因HFpEF 目前尚無有效的治療方式能改善預後。有些研究甚至發現HFpEF 的死亡率和收縮性心臟衰竭(heart failurewith reduced ejection fraction, HFrEF)是相當的。HFpEF 發生的危險因子主要是老化，高血壓及糖尿病，可以預期隨著台灣人口老化，三高普及，HFpEF 的發生率將快速增加。研究HFpEF的成因將是未來預防及藥物開發重要的依據。過去我們的團隊建立心臟核磁共振技術，可有效的定量心臟的瀰漫性纖維化(diffusefibrosis)。我們利用這項技術研究，發現HFpEF 病人心室的diffuse fibrosis 和收縮和舒張功能有顯著的相關性。後續的研究也發現，心肌diffuse fibrosis 的局部差異和心臟收縮的不一致性(dyssynchrony)強烈相關，而dyssynchrony 是心臟衰竭病患重要的預後指標。這些證據都說明diffuse fibrosis 可能是HFpEF 的主要成因，也是重要的預後因子。然而為何同樣有風險的病人，有些人會成為HFpEF 而有些人不會，目前並不清楚。在未來的三年中，我們計畫結合臨床影像，超音波，血液動力及基礎醫學等專家團隊，從核磁共振，3D 超音波，脈波動力學(pulsatile hemodynamics)，蛋白質，RNA 及動物實驗的角度研究HFpEF 並找出促成diffuse fibrosis 產生的重要因子，期待這些成果能成為臨床上治療病人的重要依據。<br> Abstract: Heart failure with preserved ejection fraction (HFpEF) has gained more and more attentionclinically not because of it's increasing prevalence with aging but also it's lack of effective treatmentto improve outcome. Some studies even found that the mortality rate of HFpEF is similar to that ofheart failure with reduced ejection fraction (HFrEF). The risk factors leading to HFpEF mainlyaging, hypertension and metabolic syndrome, therefore it is expected that with the aging of Taiwansociety and the increasing prevalence of hypertension, hyperglycemia and dyslipidemia, theprevalence of HFpEF will increase dramatically in the near future. To investigate the underlyingmechanisms of HFpEF would be important for the prevention and pharmacological treatment ofHFpEF.Previously, our research team has build up a magnetic resonance imaging (MRI) technique toeffectively quantify the degree of diffuse fibrosis of myocardium. We used this new technique toinvestigate patients with HFpEF and found that the systolic and diastolic function of HFpEF aresignificantly associated with diffuse fibrosis. Also, we found that regional variation in diffusefibrosis is significantly associated with dyssynchrony, a surrogate marker for poor prognosis inheart failure. All these evidence support the notion that diffuse fibrosis might be an importantunderlying mechanism leading to HFpEF and also a prognostic factor for poor outcome. However,the reason why some patients with risk factors develope HFpEF and others do not is not clear.In the future 3 years, we plan to incorporate specialist in different fields including clinical image,ultrasonography, pulsatile hemodynamics and basic science to investigate patients with HFpEF byusing cardiac MRI, 3D echocardiography, pulsatile hemodynamic, protein, RNA analyses andanimal study. Our goal is to uncover the potential etiologies leading to diffuse fibrosis and expectthat the results would be a valuable guide for clinical treatment.