与现有的HFpEF定义相关的差异性临床特征,运动反应和结果
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
概括
不同的心力衰竭与保存的喷射分数 (HFpEF) 定义识别了不同的患者群体和心血管事件风险. 目前的分类可能会排除许多有生理证据显示HFpEF的患者.
科学领域:
- 心脏病学
- 临床医学
- 生理学
背景情况:
- 心脏衰竭与保存的喷射分数 (HFpEF) 是一个常见的情况,没有普遍同意的定义.
- 根据用于定义HFpEF的标准,患者的临床和血液动力学概况可能有显著差异.
- 了解这些变化对于准确诊断和有效治疗至关重要.
研究的目的:
- 调查不同社会和临床试验标准对HFpEF如何影响患者特征.
- 确定应用各种HFpEF定义的生理和预后影响.
- 通过不同的HFpEF分类来比较运动反应和心血管结果.
主要方法:
- 连续接受心肺运动测试并进行侵入性血液动力学监测的慢性运动性呼吸不良和保存的喷射分数患者的分析.
- 应用已建立的HFpEF定义 (ACC/AHA,ESC,HFSA) 和临床试验标准.
- 临床特征,运动能力,血液动力学数据和长期心血管结果的比较.
主要成果:
- 在各HFpEF定义中观察到患者分类的显著差异,符合标准的患者人数从55人 (HFSA) 到416人 (ACC/ AHA).
- 运动能力 (氧气吸收峰值) 和血液动力学概况在定义之间有显著差异.
- 根据所使用的定义,心血管结局发生率差异很大,每1000人/年发生75~298例.
结论:
- 目前的HFpEF定义可变地识别出患有心血管事件风险较高的患者,但可能会排除具有该疾病生理证据的大量患者.
- HFpEF定义的异质性凸显了当前诊断标准的局限性.
- 完整的患者表型确定对于完善HFpEF分组和指导未来的治疗试验至关重要.
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