高度心力衰竭治疗中的性别差异
1Heart and Vascular Institute at the Cleveland Clinic, OH. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH.
Circulation
|February 20, 2019
概括
性别差异存在于高级心力衰竭治疗中, 了解这些差异对于优化女性和男性心力衰竭的治疗和改善结果至关重要.
科学领域:
- 心脏病学
- 医疗器械
- 移植
背景情况:
- 高度心力衰竭 (AHF) 的治疗需要复杂的治疗方法.
- 人们越来越认识到基于性别的心血管疾病患病率和结果的差异.
研究的目的:
- 审查和综合有关AHF治疗的性别差异的当前文献.
- 突出使用,有效性,不良事件和争议的差异.
主要方法:
- 对可植入心脏转移器 (ICD),双心脏起器 (BVP),机械循环支持 (MCS) 和心脏移植 (HTx) 的研究进行了全面的文献审查.
- 针对器械植入,临床有效性和患者结果的性别特异性数据进行了集中分析.
主要成果:
- 关于ICD在女性中的有效性存在争议,但建议植入.
- 在BVP反应,心力衰竭住院和死亡率上观察到的性别差异.
- 在HTx等候名单存活率和MCS设备使用率方面发现差异,女性接受LVAD的可能性较低.
- 与LVAD相似的生存率,但性别不一致的不良事件概况.
- 担心女性捐献者对男性接受者的结果可能与大小有关,而不是性别.
结论:
- 显著的性别差异影响了先进的心力衰竭治疗的有效性和利用.
- 进一步的研究对于阐明机制和定制治疗对两性改善结果至关重要.
- 优化AHF治疗需要在设备选择和管理中考虑性别特异性因素.
相关概念视频
Heart Failure VI: Adjunct Therapies
314
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
314
Heart Failure II: Pathophysiology
872
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
872
Pathophysiology of Heart Failure
3.5K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
3.5K
Heart Failure I: Introduction
847
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
847
Heart Failure Drugs: Diuretics
948
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
948
Heart Failure V: Medical Management
272
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
272


