在肥胖和呼吸障碍患者中发现未被识别的心力衰竭与保存的排泄部位
Leah B Kosyakovsky1, Elizabeth E Liu1, Jessica K Wang1
1Division of Cardiology (L.B.K., E.E.L., J.K.W., J.K.P., J.M.R., R.E.G., J.E.H.), Beth Israel Deaconess Medical Center, Boston, MA.
Circulation. Heart failure
|May 14, 2024
概括
在患有呼吸障碍的肥胖个体中,心脏衰竭与保存的喷射分数 (HFpEF) 通常无法被识别. 侵入性测试显示HFpEF在三分之一以上,突出非侵入性诊断方法的局限性.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 肥胖医学 肥胖医学
背景情况:
- 保存喷射分数 (HFpEF) 的心力衰竭是最常见的心力衰竭类型,但经常被诊断不足.
- 肥胖症使HFpEF诊断复杂化,原因是传统生物标志物的局限性,如尿酸和静止心声学.
- 准确的HFpEF诊断对于有效的管理和改善患者结果至关重要.
研究的目的:
- 为了调查肥胖和呼吸障碍但没有已知的心血管疾病的个体中血液动力学确认的HFpEF的患病率.
- 为了在这个特定的患者群体中比较HFpEF的侵入性和非侵入性诊断标准.
- 评估当前的非侵入性方法在识别肥胖个体中HFpEF的诊断效用.
主要方法:
- 78名患有肥胖和呼吸障碍的参与者接受了静止心声扫描.
- 怀疑肺高血压的个体进行了侵入性心肺运动测试 (CPET).
- 根据已确定的肺毛细血管压 (PCWP) 标准,在休息或运动期间诊断出HFpEF.
主要成果:
- 在78名参与者中,有40人 (51%) 接受了CPET. 在24名参与者中诊断出HFpEF (31%的总样本).
- 在具有和没有HFpEF的患者之间,没有观察到NT-proBNP水平或休息时心声学参数 (mitral E/e'比) 的显著差异.
- HFpEF诊断分数 (H2FPEF,HFA-PEFF) 显示了类似的分布,大多数参与者被归类为中等风险.
结论:
- 至少有三分之一的肥胖和呼吸障碍的成年人没有已知的心血管疾病,没有被识别的HFpEF,通常通过侵入性CPET识别.
- 非侵入性临床评估,生物标志物和静止心电回声学显示,在这个队列中区分HFpEF的能力有限.
- 这些发现强调了在肥胖个体中诊断HFpEF的重大挑战以及当前非侵入性诊断策略的局限性.
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