心力衰竭患者的微血管功能障碍与保存的喷射分数:一个元分析
Mai Azuma1, Shingo Kato2, Kazuki Fukui1
1Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
Microcirculation (New York, N.Y. : 1994)
|July 26, 2023
概括
微血管功能障碍 (MVD) 影响了超过50%的心力衰竭患者,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中,心力衰竭患者中. 这种情况显著影响患者的预后,是HFpEF病理生理学的关键因素.
科学领域:
- 心脏病学 心脏病学
- 内部医学 内部医学
- 病理生理学 病理生理学
背景情况:
- 微血管功能障碍 (MVD) 是心力衰竭的疑似关键因素,其中保留喷射分数 (HFpEF).
- 在HFpEF患者中,MVD的确切患病率和预后意义尚不清楚.
- 了解MVD的作用对于改善HFpEF管理至关重要.
研究的目的:
- 为了确定诊断为HFpEF的患者中MVD的频率.
- 评估HFpEF患者中MVD的预后价值.
- 评估MVD在HFpEF风险分层中的实用性.
主要方法:
- 通过使用9项研究的数据进行了元分析,其中包括941名HFpEF患者.
- 在主要数据库 (PubMed,科学网,Cochrane,Embase) 进行了文献搜索.
- 使用一般逆方差方法计算了患病率;综合审查了预后关联.
主要成果:
- 分析发现MVD在55.5%的HFpEF患者中存在 (95%CI:34.8%-76.2%),具有很高的异质性.
- 在检查预后的五项研究中,有四项报告说MVD和不良结果之间存在显著的关联.
- 在流行数据中发现了显著的异质性 (I2=98%).
结论:
- 大约一半的HFpEF患者表现出微血管功能障碍.
- 在HFpEF中,MVD的存在与更差的预后有显著的联系.
- MVD是心力衰竭的关键病理生理成分,具有保存的喷射分数.
相关概念视频
01:29Heart Failure II: Pathophysiology
16
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...
16
01:17Pathophysiology of Heart Failure
1.6K
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...
1.6K
01:30Heart Failure V: Medical Management
14
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...
14
01:22Heart Failure Drugs: Diuretics
422
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...
422
01:27Heart Failure I: Introduction
18
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...
18
01:26Heart Failure III: Clinical Manifestations
24
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
24