在高风险人群中对B期心力衰竭进行分类的挑战
Alice C Cowley1,2, Abhishek Dattani1,2, Jian L Yeo1,2
1Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK.
Journal of cardiovascular development and disease
|January 27, 2026
概括
目前针对B期心力衰竭 (SBHF) 的指导方针缺乏具体性. 通过性别和种族特异性值来完善标准,可以更好地识别患有症状疾病风险的个人.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 糖尿病研究 糖尿病研究
背景情况:
- 乙期心力衰竭 (SBHF) 构成患有症状性心力衰竭 (HF) 的重大风险.
- 现有的SBHF诊断标准缺乏性别和种族特异性,以及对心磁共振 (CMR) 影像成像的定义值.
- 需要评估不同人群中的SBHF患病率,并完善诊断标准.
研究的目的:
- 为了评估SBHF在2型糖尿病 (T2D) 和健康对照患者的大群中SBHF的患病率.
- 为诊断SBHF提出精细的,性别和种族特定的CMR成像标准.
- 为了比较A阶段和B阶段HF分类之间的患者特征和运动能力.
主要方法:
- 从使用CMR电影成像的373名健康对照人群中推导出性别和种族特定的值.
- 将当前和精细的SBHF标准应用于T2D无症状个体队列和具有症状心血管疾病 (大动脉狭窄和HFpEF) 的历史队列.
- 计算了SBHF患病率,比较了包括运动能力在内的患者特征,并在有症状的队列中评估了心脏重塑.
主要成果:
- 目前的标准确定了91%的T2D个体和69%的健康对照为SBHF,表明特异性差.
- 改进的标准,包括性别和种族特定的值和回声/CMR测量,将SBHF患病率降低到T2D队列中的30%.
- 与A级HF相比,被归类为精细B级HF的个体表现出较低的运动能力 (81%对91%的预测最大氧气消耗,p<0.001).
- 精确的标准确定了89%的严重大动脉狭窄和85%的HFpEF参与者的异常心脏重塑.
结论:
- 目前的SBHF指南标准是非特定的,具有有限的临床实用性.
- 性别和种族特定的门可以提高对有症状心力衰竭风险的个体的识别.
- 需要进一步的研究来验证SBHF诊断所提出的精细标准.
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