潜在未诊断的HFpEF对冠状动脉再血管化的症状反应的影响
Nicholas P Bergeron1, Alexander C Egbe1, William R Miranda1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC. Heart failure
|January 13, 2026
概括
许多患有冠状动脉疾病 (CAD) 和呼吸障碍的患者有未被诊断的心力衰竭与保存的射出分数 (HFpEF). 侵入性策略改善了症状,但没有降低住院风险,这表明HFpEF需要独立评估.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭研究研究
- 诊断策略 诊断策略
背景情况:
- 患有心力衰竭和保存喷射分数 (HFpEF) 的患者经历了生活质量 (QOL) 的降低和冠状动脉疾病 (CAD) 的高负担.
- 由于诊断的复杂性,有限的证据指导HFpEF患者的重血管化.
研究的目的:
- 确定CAD患者未被诊断的HFpEF的患病率和积极的压力测试结果.
- 评估侵入性策略对这些患者的QOL的影响.
主要方法:
- 从ISCHEMIA试验中使用Rose Dyspnea Scale和HFpEF-ABA概率对患者进行了分层,分为可能的HFpEF,可能的HFpEF和没有HFpEF的组.
- 使用混合模型评估侵入性策略对健康状况的影响.
- 在单独的队列中使用运动右侧心脏导管治疗验证的HFpEF流行率.
主要成果:
- 超过一半的参与者 (53.4%) 患有呼吸障碍,并面临HFpEF的风险 (9.0%可能,44.4%可能).
- 可能的HFpEF患者有较差的运动能力,心痛,呼吸不全和QOL,尽管阻塞性CAD较小.
- 侵入性策略改善了各组的症状 (呼吸不全,心痛) 和QOL,对可能的HFpEF患者有更大的益处,但没有降低HF住院风险.
结论:
- 在患有呼吸障碍的CAD患者中,很大一部分患者没有诊断出HFpEF.
- 患有可能的HFpEF的患者面临着最高的住院风险和症状负担,从身体限制和心痛的侵入性策略中获益最多.
- 再血管化后的残留症状和持续住院风险突出显示,需要在患有呼吸不良的CAD患者中进行独立的HFpEF评估.
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