射出 分数 を 減少 さ せ た 心臓 衰弱: 概要
Sean P Murphy1, Nasrien E Ibrahim2,3, James L Januzzi2,3,4
1Department of Medicine, Massachusetts General Hospital, Boston.
JAMA
|August 5, 2020
まとめ
心臓機能不全とエジェクション分数減少 (HFrEF) は,世界中で何百万もの患者を抱えています. 最近のSGLT2阻害剤や投与ゲートなどの治療法の進歩により,治療結果が改善されていますが,有意な罹病率と死亡率は依然として維持されています.
科学分野:
- 心臓病科
- 内科 医学
- 薬理学について
背景:
- 心不全 (HF) は,世界的に健康上の懸念が高まっており,心不全の排出分数 (HFrEF) が約50%を占めている.
- HFrEFは,左心室排出分数 (LVEF) が40%以下で,心室機能不全,膨張,有害な心臓再構成によって特徴付けられています.
研究 の 目的:
- 心不全の診断と治療の現状を概説する.
- HFrEFの管理における最近の進歩と患者の結果への影響を強調する.
主な方法:
- 診断には,臨床的評価,ナトリウレチンペプチドの上昇,およびLVEFのエコーカルディオグラフィの識別が含まれる.
- 治療戦略には,基礎的な神経ホルモン療法 (β阻害剤,ACE阻害剤/ARB/RNAI,MRA) が含まれており,SGLT2阻害剤や vericiguatなどの追加の薬剤が使用されています.
- 心臓再同期療法とトランスキャテータによるミトラル弁修復を含む器具療法が,特定の患者のサブグループで検討されています.
主要な成果:
- 基礎療法はHFrEFでの結果を大幅に改善します.
- SGLT2阻害剤は,糖尿病状態に関係なく,心血管疾患およびあらゆる原因による死亡率を減少させます.
- Vericiguatは,高リスクのHFrEF患者における心不全入院の減少を示しています.
結論:
- HFrEFは依然として高い罹病率と死亡率で公衆衛生上の大きな課題です.
- SGLT2阻害剤と伝達剤を含む最近の治療の進歩は 予後を大幅に改善しました
- 進歩にもかかわらず,入院後の5年間の生存率は25%であり,継続的な研究と最適化された患者のケアが必要であることを強調しています.
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