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你如何管理这位心力衰竭的患者,用保存的喷射部分? :从伯特以色列执事女医疗中心进行大轮讨论
Gerald W Smetana1, Jennifer E Ho1, Ariela R Orkaby2
1Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S., J.E.H., E.E.R.).
Annals of internal medicine
|December 11, 2023
概括
保存喷射分数 (HFpEF) 的心力衰竭越来越常见,并且难以诊断. 新的指导方针为这种主导性心力衰竭亚型提供了除利尿剂之外的扩展治疗选择.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 心脏衰竭研究研究
背景情况:
- 保存喷射分数 (HFpEF) 的心力衰竭是一个日益增长的临床挑战,现在比减少喷射分数 (HFrEF) 的心力衰竭更普遍.
- HFpEF诊断是复杂的,因为症状与其他疾病重叠,并且经常有微妙的身体发现,导致潜在的诊断不足.
- HFpEF的危险因素包括人口老龄化,肥胖和心脏代谢疾病.
研究的目的:
- 讨论HFpEF不断发展的诊断和管理.
- 要突出最近对HFpEF治疗的指导方针更新.
- 介绍专家关于将指南应用于个人患者护理的观点.
主要方法:
- 审查主要心脏病学和心力衰竭学会最近的指导方针 (2022年ACC/AHA/HFSA,2023年ACC专家共识).
- 与HFrEF相比,HFpEF的诊断挑战的讨论.
- 一位心脏病学家和一位老年医生对临床应用的专家评论.
主要成果:
- 利尿剂仍然是HFpEF拥堵管理的第一类建议.
- 建议使用-葡萄糖携带载体-2 抑制剂 (SGLT2i) (2a 类) 和血管激素受体-尼普利辛抑制剂 (ARNI) (2b 类).
- 最近的途径建议根据性别,射出分数,拥堵和SGLT2i候选性量身定制HFpEF治疗.
结论:
- 诊断HFpEF需要仔细考虑超出典型的HFrEF标记.
- 药理学的进步,包括SGLT2i和ARNI,提供了新的治疗途径.
- 个性化管理策略对于优化HFpEF患者的治疗结果至关重要.
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