心脏衰竭中的肥胖与保存的喷射分数:来自REDUCE LAP-HF II试验的见解
Sheldon E Litwin1,2, Jan Komtebedde3, Tim Seidler4
1Medical University of South Carolina, Charleston, SC, USA.
European journal of heart failure
|November 21, 2023
概括
肥胖严重程度的增加加剧了心力衰竭与保存的喷射分数 (HFpEF) 症状和心力衰竭事件. 然而,许多肥胖的HFpEF患者可能仍然受益于心房分流疗法,因为心脏功能得到保护.
科学领域:
- 心脏病学 心脏病学
- 肥胖医学 肥胖医学
- 医疗器械 医疗器械
背景情况:
- 肥胖是心力衰竭的已知危险因素之一,具有保存的喷射分数 (HFpEF).
- 肥胖使HFpEF的诊断和管理变得复杂.
- 了解肥胖严重程度对HFpEF病理生理学的影响至关重要.
研究的目的:
- 研究肥胖严重程度与HFpEF患者的临床,心声和血液动力学参数之间的关系.
- 评估增加身体质量指数 (BMI) 如何影响HFpEF中的症状,身体限制和生活质量.
- 为了确定肥胖是否会影响HFpEF的心房分流疗法的有效性.
主要方法:
- 来自REDUCE LAP-HF II试验的数据分析,随机将626名HFpEF患者 (射出分数≥40%) 分给心房分流或假手术.
- 在BMI和临床特征,心脏结构/功能,身体限制,生活质量和结果之间进行关联测试.
- 评估心声学和血液动力学参数,包括心脏填充压力,心脏输出和肺血管阻力.
主要成果:
- 较高的BMI与症状恶化相关 (堪萨斯市心肌病问卷得分) 和减少6分钟的步行距离.
- 增加肥胖症的严重程度与更高的心脏填充压力和心脏输出有关,尽管天然尿素水平较低.
- 肥胖与更多的心力衰竭事件有关,但没有发现与心房旁路疗法的有效性有显著的相互作用.
结论:
- 在HFpEF患者中,较大的肥胖严重程度与心脏重塑增加,填充压力增加,心脏输出量增加和更多心力衰竭事件有关.
- 尽管肥胖,许多HFpEF患者表现出保存的右心脏和肺血管功能.
- 这些发现表明,肥胖的HFpEF患者具有保留的功能可能是心房旁路治疗的合适候选人.
相关概念视频
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
01:22Heart Failure Drugs: β-Blockers
344
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
344
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
436
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
436
01:22Heart Failure Drugs: Diuretics
398
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...
398
01:26Heart Failure Drugs: Inotropic Agents
596
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
596
01:24Obesity
507
The Body Mass Index (BMI) is a numerical value derived from a person's weight and height, used to categorize individuals into weight ranges. It is calculated using the formula: weight in kilograms divided by height in meters squared. Obesity is a health condition characterized by excessive accumulation of adipose tissue that poses health risks, often diagnosed with a BMI ≥ 30. This excess fat storage occurs when surplus dietary calories are converted into triglycerides and stored in...
507