在急性不补偿性心力衰竭中HFpEF和HFmrEF:孤立的透气功能障碍或其他心脏病理?
1Institute of Cardiology, ASST Spedali Civili Di Brescia, Brescia, Italy. m.bellicini003@unibs.it.
Internal and emergency medicine
|August 23, 2025
概括
急性心力衰竭住院通常涉及心力衰竭与保存的喷射分数 (HFpEF) 或轻微减少的喷射分数 (HFmrEF). 这项研究表明,严格定义的这些情况很少独立导致液体过载,挑战目前的诊断指南.
科学领域:
- 心脏病学
- 心脏衰竭的病理生理学
- 临床诊断
背景情况:
- 在急性心力衰竭 (AHF) 住院患者中,有很大一部分是心力衰竭患者,其排气分数保持 (HFpEF) 或轻微减少 (HFmrEF).
- 目前的指导方针通过排除主要心脏病态来定义这些表型,并仅将症状归因于心经舒张功能障碍.
- 在指南中定义的HFpEF/HFmrEF对流体过载的独立贡献尚未得到证实.
研究的目的:
- 在患有保留或轻微减少的喷射分数 (LVEF> 40%) 的患者中,研究模仿HFpEF的主要心脏结构和节律异常的患病率.
- 确定指导方针定义的HFpEF/HFmrEF是否可以独立引起急性减补和流体过载.
主要方法:
- 在2022年1月至2023年11月期间,连续773次心脏病诊断的回顾性分析.
- 包括323名左心室喷射分数 (LVEF) > 40%的患者.
- 系统性静脉堵塞定义为下腔静脉直径> 21毫米与减少的吸入性崩.
- 结构化诊断方法以识别HFpEF模仿物,包括严重的膜疾病,心肌病和功能衰竭.
主要成果:
- 在323名LVEF> 40%的患者中,有252名 (78%) 患有全身血栓塞.
- 在患有血栓塞的患者中,206人 (81. 7%) 患有严重的功能障碍,26人 (10. 3%) 患有其他心脏病变或功能衰竭,只有20人 (8%) 符合HFpEF的严格定义.
- 在LVEF> 40%的患者中,全身静脉堵塞几乎总是与显著的结构性/节律性心脏病或晚期功能衰竭有关.
结论:
- 在指南中定义的HFpEF/HFmrEF作为急性失补偿的独立原因似乎不常见或不存在.
- 这些发现挑战了HFpEF/HFmrEF在急性失补偿的现有定义的有效性.
- 对于患有AHF和保存或轻微减少的喷射分数的患者,建议采用更全面的诊断方法.
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