心脏衰竭与减少的喷射小部分:一个回顾
Sean P Murphy1, Nasrien E Ibrahim2,3, James L Januzzi2,3,4
1Department of Medicine, Massachusetts General Hospital, Boston.
JAMA
|August 5, 2020
概括
全球有数以百万计的人患有心力衰竭. 最近的治疗进展,如SGLT2抑制剂和放疗剂提供了更好的结果,尽管显著的发病率和死亡率仍然存在.
科学领域:
- 心脏病学
- 内部医学
- 药理学
背景情况:
- 心力衰竭 (HF) 是一个日益严重的全球健康问题,心力衰竭减少排泄率 (HFrEF) 约占病例的50%.
- HFrEF的定义是左心室喷射率 (LVEF) 40%或更低,其特征是心室功能障碍,扩张和不良心脏重塑.
研究的目的:
- 概述目前心力衰竭的诊断和治疗情况.
- 突出HFrEF管理的最新进展及其对患者结果的影响.
主要方法:
- 诊断包括临床评估,尿素水平升高和LVEF≤40%的心声识别.
- 治疗策略包括基础神经激素疗法 (β阻塞剂,ACE抑制剂/ARB/RNAI,MRA),以及其他药物,如SGLT2抑制剂和 vericiguat.
- 对于特定的患者小组,考虑使用设备治疗,包括心脏再同步治疗和跨导管 mitra 修复.
主要成果:
- 基础疗法显著改善了HFrEF的结果.
- 不管糖尿病状况如何,-葡萄糖共运输体2 (SGLT2) 抑制剂都能降低心血管和全因死亡率.
- 在高风险的HFrEF患者中,Vericiguat可以减少心力衰竭住院.
结论:
- 由于高发病率和高死亡率,HFrEF仍然是一个重大的公共卫生挑战.
- 最近的治疗突破,包括SGLT2抑制剂和放疗剂, 已经大大改善了预后.
- 尽管取得了进展,但住院后的5年生存率为25%,这表明需要继续研究和优化患者护理.
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