轻微减少的功能与患有多变性心肌病的患者心力衰竭入院增加有关
Nan Young Bae1, Tae-Min Rhee2, Chan Soon Park1
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Journal of Korean medical science
|March 5, 2024
概括
即使是轻微减少的功能在缩性心肌病 (HCM) 患者显著增加重大心血管不良事件 (MACEs) 的风险,特别是心力衰竭住院治疗.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 临床结果研究研究
背景情况:
- 功能受损与高性心肌病 (HCM) 中心血管预后之间的联系尚未得到充分证实.
- 这项研究研究了降低估计的淋巴细胞过率 (eGFR) 和HCM患者的不良心血管结果之间的关联.
研究的目的:
- 为了确定轻微降低功能是否与被诊断为患有多变性心肌病的患者的预后更差有关.
- 在功能不同阶段的HCM患者中量化主要不良心血管事件 (MACE) 的风险.
主要方法:
- 分析了1,756名患有HCM的患者,不包括透析患者或先前心力衰竭或中风患者.
- 根据eGFR,患者被分为I阶段 (≥90),II阶段 (60-89) 和III-V阶段 (<60毫升/分钟/1.73米2).
- 主要不良心血管事件 (MACE),包括心血管死亡,心力衰竭住院治疗 (HHF) 和中风,使用多变量Cox回归追踪了平均4.0年.
主要成果:
- 患有III-V期功能的患者患MACE的风险增加了2.71倍 (P=0.003),主要是心血管死亡和HHF.
- 即使是II期功能 (eGFR 60-89 mL/min/1.73 m2) 与I期相比,也与MACE风险增加2.21倍 (P=0.008) 和HHF风险增加2.62倍 (P=0.012) 相关.
- 这些发现强调了降低EGFR和HCM队列中不良心血管结果之间的显著关联.
结论:
- 在HCM患者中,轻微降低功能 (eGFR 60-89 mL/min/1.73 m2) 与MACEs的风险显著增加有关.
- 由于心力衰竭 (HHF) 住院治疗是功能减弱患者MACEs增加的主要驱动因素.
- 这些结果强调了监测功能在HCM管理中的重要性,以改善心血管风险分层.
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: Diuretics
375
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...
375
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
429
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...
429
01:26Imbalances in Cardiac Output
1.4K
The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
1.4K
01:22Heart Failure Drugs: β-Blockers
338
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,...
338
01:26Heart Failure Drugs: Inotropic Agents
586
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...
586