摘要
心力衰竭是心脏疾病发展的终末阶段。既往研究根据左心室射血分数将心力衰竭分为两种类型:射血分数保留的心力衰竭(HFpEF)和射血分数降低的心力衰竭(HFrEF)。而2016年欧洲心脏病学会(ESC)心力衰竭指南根据左心室射血分数将心力衰竭分为HFrEF、射血分数中间值心力衰竭(HFmrEF)及HFpEF。本文通过对HFrEF、HFmrEF及HFpEF的流行病学、临床特征、病理生理学、预后及治疗等方面进行总结分析,发现HFmrEF可能是HFrEF及HFpEF的中间和过渡型。目前在HFmrEF诊疗策略的多个方面仍有待进一步验证,比如更积极地抗心肌缺血治疗及射血分数动态监测对心肌细胞的保护价值;心血管和非心血管疾病合并症的筛查协助认识HFmrEF病理生理特征的临床价值;心脏磁共振成像检查对HFmrEF病理生理学改变的诊断价值;C端成纤维细胞生长因子23(cFGF23)和冠状窦神经肽Y(NPY)水平在HFmrEF中的风险预测和临床转归上的作用价值。更深入地探索与研究会进一步提高临床医生对HFmrEF发病机制与临床特征的理解,利于制定更有效的诊疗策略。
Heart failure is the final stage of the development of heart disease.Previous studies classified heart failure into two types based on left ventricular ejection fraction:heart failure with preserved ejection fraction(HFpEF)and heart failure with reduced ejection fraction(HFrEF).But according to the 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure,heart failure is categorized into HFpEF,HFrEF and heart failure with mid-range ejection fraction(HFmrEF)based on the LVEF.The comparison of epidemiology,clinical characteristics,pathophysiology,treatment and prognosis among the patients with HFrEF,HFmrEF and HFpEF suggests that HFmrEF may be an intermediate phenotype between HFrEF and HFpEF.There are still many diagnosis and treatment strategies for HFmrEF that need to be further explored,such as finding active anti-myocardial ischemia therapies and examining the protective value of ambulatory monitoring of ejection fraction for cardiomyocytes,clinical value of screening for cardiovascular and non-cardiovascular comorbidities in understanding the pathophysiological characteristics of HFmrEF,the diagnostic value of cardiac MRI for pathophysiological changes of HFmrEF,and values of cFGF23 and NPY levels in risk and clinical outcome prediction of HFmrEF.The exploration and research of more relevant information will contribute to improving clinicians'understanding of the pathogenesis and characteristics of HFmrEF to develop effective diagnosis and treatment strategies.
作者
石芳娥
朱继红
SHI Fang'e;ZHU Jihong(Department of Emergency Medicine,Peking University People's Hospital,Beijing 100044,China)
出处
《中国全科医学》
CAS
北大核心
2021年第5期526-532,共7页
Chinese General Practice
基金
北京市科技计划项目(Z161100000516045)。
关键词
心力衰竭
射血分数中间值心力衰竭
临床特征
综述
Heart failure
Heart failure with mid-range ejection fraction
Clinical characteristics
Review
