心血管
词汇介绍
拓展阅读
解析
Heart failure
释义 inability of the heart to pump enough blood to sustain normal bodily functions 心力衰竭
例句 Acute heart failure is a clinical syndrome.
急性心力衰竭是一个临床综合征。
Preserved 英 /prɪ'zɜːvd/ 美 /prɪ'zɝv/
释义 adj. 保留的,保藏的;腌制的;喝醉的
例句 The yolk sac and yolk stalk on one of them were well preserved.
其中1个卵黄囊和卵黄蒂保存完好。
ejection fraction
短语 Peak Velocity Ejection Fraction 峰值射血率;left ventriettlar ejection fraction 左室射血分数
概述
概述
射血分数保留型心力衰竭(HFpEF)是一种临床综合征,患者有心衰的症状和体征,左心室射血分数(LVEF)正常或接近正常(即≥50%),且有证据表明心脏功能障碍(例如,左室充盈异常和充盈压升高)是其症状原因。以前将HFpEF称为舒张性心力衰竭。
病因
典型的HFpEF通常与以下因素相关:收缩期高血压,无论是否伴有左心室肥厚;老龄;冠状动脉心脏病;糖尿病;睡眠呼吸障碍;肥胖;肾脏疾病。
病理生理学
左心室在不升高肺静脉压的情况下能充分充盈需满足以下条件:适当的收缩期射血;能够通过压缩左室弹性组织来储存部分收缩能量;心肌能正常松弛(这是需要代谢能量的主动过程);左室有适当的舒张可扩张性(被动性)。心室腔过小和肌联蛋白和/或胶原蛋白不适当改变(这两者决定心室的僵硬度)时,心室的可扩张性降低。有舒张功能障碍时,左室充盈产生适当的心输出量需升高肺静脉压。这可能发生于静息时,也可能仅为应激(如运动)反应。肺静脉压升高可导致肺循环淤血和肺高压。HFpEF患者出现运动不耐受可能是由于左房压和肺静脉压增高和/或心输出量减少导致呼吸困难和乏力。
临床表现
HFpEF的临床表现包括呼吸困难(劳力性呼吸困难、夜间阵发性呼吸困难和端坐呼吸)、乏力、颈静脉压升高、肺啰音和下肢水肿。很多患者表现为劳力性胸痛症状,如果这类患者没有明显的心外膜冠状动脉疾病,应考虑为HFpEF。
生物标记物
测定血浆脑利钠肽(BNP)或N 末端脑钠肽前体(NT-proBNP)水平有助于确诊心衰和评估预后,但其结果的敏感性和特异性有限,应谨慎解读。HFpEF患者的BNP和NT-proBNP升高,BNP>100 pg/mL、NT-proBNP>300 pg/mL是HFpEF患者不良心血管事件的独立预测因素。
超声心动图
心脏超声是诊断和评估疑似HFpEF患者的重要手段,有助于证实LVEF和左室容量是否正常。超声还可发现LVH或左室向心性重构、左心房肥大及舒张功能障碍。HFpEF患者的超声心动图评估常可发现肺动脉收缩压(PASP)升高,当发现呼吸困难老年人存在PASP升高时应考虑HFpEF。
诊断
一般结合病史询问、体格检查和超声心动图检查(可能加用血浆BNP水平测定或心肺运动试验等)做出该诊断。
治疗
改善HFpEF 预后的治疗方法不明确。目前,对于血液动力学机制的症状,例如左房高压,肺动脉高压和容量超负荷,对症通过心房间隔装置、PAP 监测仪、利尿剂和肾素-血管紧张素-醛固酮抑制剂 进行治疗。
Heart failure with preserved ejection fraction: from mechanisms to therapies复制标题
射血分数保留的心力衰竭: 从机制到治疗
发表时间:2018-08-01
影响指数:23.4
作者: Carolyn S P Lam
期刊:Eur. Heart J.
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms of HF, a left ventricular ejection fraction (LVEF) ≥50 percent, and evidence of cardiac dysfunction as a cause of symptoms (eg, abnormal LV filling and elevated filling pressures). When diagnosing HFpEF, it is important to exclude mimics including non-HF conditions as well as other causes of HF with an LVEF ≥50 percent, such as valvular heart disease, pericardial disease, cardiomyopathies, cardiac amyloidosis, and high output HF. The major contributors to HFpEF are systemic hypertension, aging, coronary artery disease, diabetes and metabolic syndrome, obesity, and kidney disease. Occult coronary heart disease is a common and potentially reversible cause of HFpEF. Plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) may be elevated or normal in patients with HFpEF. Natriuretic peptide levels should be interpreted with attention to potential confounding factors including renal failure (which causes elevated BNP levels and even greater elevation in NT-proBNP levels), obesity (which tends to depress BNP and NT-proBNP levels), as well as conditions other than left-sided HF that cause elevations in levels.
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