既存のHFpEF定義に関連した異なる臨床プロファイル,運動反応,および結果
Jennifer E Ho1,2, Emily K Zern3, Luke Wooster2
1Cardiovascular Research Center (J.E.H., R.M.), Massachusetts General Hospital, Boston.
Circulation
|May 29, 2019
まとめ
保存されたエジェクション分数 (HFpEF) の心不全の異なる定義は,異なる患者グループと心血管疾患のリスクを特定します. 現在の分類では,HFpEFの生理学的証拠を持つ多くの患者が除外される可能性があります.
科学分野:
- 心臓病科
- 臨床医学
- 生理学
背景:
- 発射分子が保存された心不全 (HFpEF) は,普遍的に合意された定義のない一般的な状態です.
- HFpEFを定義するために使用された基準に基づいて,患者の臨床的および血液動力学的プロファイルは著しく異なる可能性があります.
- 正確な診断と効果的な治療のために これらの変化を理解することは極めて重要です
研究 の 目的:
- HFpEFの社会的および臨床試験の異なる基準が患者の特徴にどのように影響するか調査する.
- 様々なHFpEFの定義を適用することで生理学的および予後的な影響を決定する.
- 異なるHFpEF分類における運動反応と心血管のアウトカムを比較する
主な方法:
- 慢性的な運動呼吸不全と保存されたエジェクション分数の連続した患者を分析し,侵入性血液動力学的モニタリングで心肺運動テストを行った.
- 確立されたHFpEF定義 (ACC/AHA,ESC,HFSA) と臨床試験基準の適用
- 臨床プロフィール,運動能力,血液動力学的データ,および長期の心血管のアウトカムを比較.
主要な成果:
- HFpEFの定義によって患者の分類に重大な差異が認められ,基準を満たした患者の数は55人 (HFSA) から416人 (ACC/ AHA) であった.
- 運動能力 (最大酸素吸収量) と血液動力学的プロファイルは,定義によって顕著に異なっていた.
- 心血管疾患の発生率は,適用された定義に応じて,1,000人年あたり75~298例であった.
結論:
- HFpEFの現在の定義は,心血管疾患のリスクが高い患者を変化的に特定しますが,この状態の生理学的証拠を持つ患者のかなりの割合を除外することがあります.
- HFpEFの定義の多様性は,現在の診断基準の限界を強調しています.
- HFpEFのサブグループ化を精進し,将来の治療試験を導くために,包括的な患者フェノタイプ化は不可欠です.
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