International Circulation: You mentioned the HFrEF and HFpEF， we know there are obviously some differences there.  Can you give us some clinical diagnosis in management of those two?

　　《国际循环》：您刚才提到了HFrEF与HFpEF，我们知道两者有很多显著的差异。能否请您介绍一下就两者的管理而言，其临床诊断方面有哪些差异？

　　Dr. Jessup: I think HFrEF is more likely to be men who have coronary disease and who have myocardial infarctions. HFrEF means that not only is there reduced ejection fraction but the left ventricle has become dilated and big， and usually the left ventricle may be dilated， but the right ventricle may be dilated as well. HFpEF is more often seen in women and is less often associated with coronary artery disease especially with myocardial infarction. In these hearts and in these patients， the heart is not dilated but the left ventricles may be hypertrophied and the atrium may be very enlarged， so there is a higher population of patients that have atrial fibrillation as well. As I said， it is not very clear the optimal management of HFpEF and other than symptomatic control of their atrial fibrillation rate， controlling their volume， controlling their blood pressure， looking for coronary artery disease， with HFrEF we have many trials that have shown the effectiveness of standard medical treatment.

　　Jessup教授：我认为，HFrEF患者中合并冠心病尤其心肌梗死男性比例更高。该类患者不仅射血分数降低，还通常伴有左室扩张；此外，右心室也可出现扩张。HFpEF则更多见于女性，在冠心病尤其心肌梗死患者中较少见。HFpEF患者的心脏并不扩张，但左心室可能伴有肥厚，心房可能存在扩大，故常合并心房颤动。正如刚才我所提到，除心房颤动对症治疗、血压控制以外，目前HFpEF最佳管理方面仍不清楚。而就HFrEF而言，则已经有多项临床试验证明了标准药物治疗的有效性。