俯身呼吸困难与慢性心力衰竭患者不良预后关系的Meta分析

目的：系统评价俯身呼吸困难与慢性心力衰竭（心衰）患者发生不良预后的关系。方法：计算机检索Embase、Ovid、Cochrane图书馆、Web of Science、PubMed、中国生物医学文献数据库、中国知网、维普数据库、万方数据库等多个数据库自建库起至2021年9月31日的所有文献,并进行筛选文献、提取信息、质量评价,采用RevMan 5.3软件对纳入文献进行Meta分析。结果：共纳入9篇文献,总计9项研究1 652例慢性心衰患者。存在俯身呼吸困难心衰患者的心衰再入院（RR=1.85,95%CI:1.34～2.56,P=0.0002）、心原性死亡（RR=1.50, 95%CI:1.20～1.89,P=0.0004）、复合心血管不良事件（RR=1.54,95%CI:1.24～1.91,P=0.0001）的发生风险均显著高于无俯身呼吸困难心衰患者。其中,复合心血管不良事件包括再入院、死亡、左心室辅助装置植入、急性心肌梗死、心律失常、心脏移植等。亚组结果显示,俯身呼吸困难与慢性心衰再入院的关联强度在不同心衰类型、年龄、评估方式、风险效应指标值方面的差异都具有统计学意义（P均<0....     

射血分数正常心力衰竭

本文简述了射血分数正常心力衰竭,又称为射血分数保存心力衰竭(收缩功能保存心力衰竭)的流行病学,并比较了其与射血功能低下心力衰竭(收缩功能低下心力衰竭)的预后。概述了其病因与病理生理特点、诊断要点及治疗原则。     

射血分数正常的心力衰竭

左室射血分数在正常范围内的心力衰竭近来受到关注,现将其在病因、病理生理、组织多普勒成像及治疗策略方面的研究进展综述如下。     

左心室射血分数正常的心力衰竭

<正>近年来,左心室射血分数(left ventricularej ection fraction,LVEF)正常的心力衰竭(心衰)得到了心血管专业医生越来越多的重视,特别是近来研究发现其高发病率及和收缩性心衰相比毫不逊色的住院率、病死率使其成为了临床工作的重点之一。各家对此认知不同。     

射血分数正常的心力衰竭患者临床特点分析

目的:探讨国人射血分数正常的心力衰竭(HFPEF)患者的临床特点及治疗状况.方法:对我院2007年10月至2008年5月收治的心力衰竭(NYHA Ⅲ-Ⅳ级)患者中EF≥50%和EF<50%的患者的临床资料进行对照分析.结果:494例心力衰竭患者中左室收缩功能正常(EF≥50%)者327例(66.2%).与EF<50%的患者相比,HFPEF患者年龄更大(69.0∶60.6)岁,女性(51.7∶35.3)%、高血压(70.3∶34.1)%与贫血患者(22.0∶9.0)%更多;左室相对室壁厚度更大(0.47∶0.30);接受钙拮抗剂治疗者(47.7∶6.0)%较多,而应用利尿剂(43.7∶ 88.6)%与β受体阻滞剂(42.2∶60.5)%者较少.虽然HFPEF患者血浆脑钠肽明显低于EF<50%患者,但住院期间2组的死亡率差异无统计学意义(1.8∶2.4)%.结论:收缩功能正常在中度以上的国人心力衰竭患者中颇为常见,住院期间死亡率与EF降低的心力衰竭患者相近.     

射血分数不降低的心力衰竭患者的死亡

7月20日的NEJM发表的2篇报导反映，射血分数（EF）不降低的心力衰竭（简称心衰）病例日渐多见，造成一定数量的死亡。其中一篇反映，一般认为EF不降低者较为良性，实则其病死率与EF低者近似；另一篇则报导，目前仅EF低者改善生存率。这组作者称：“这些观察提示近一段时间较多心衰患者生存率提高，可能主要是由于EF降低病例生存率的提高”。     

射血分数正常心力衰竭的诊治进展

2005年,美国心脏病学会（ACC）和美国心脏病协会（AHA）在《成人慢性心力衰竭诊断与治疗指南》。中采用“射血分数正常的心力衰竭”（HFNEF）替代了“舒张性心力衰竭（DHF）”的概念。2010年9月9日,国际循环网在线发布了《射血分数正常心力衰竭诊治的中国专家共识》,在中国专家共识中正式采用HFNEF取代DHF的概念。本文结合近年来的文献,对HFNEF的诊治进展综述如下。     

心房颤动对慢性收缩性心力衰竭患者和射血分数正常心力衰竭患者预后的影响

目的 探讨心房颤动（简称房颤）对慢性收缩性心力衰竭（CSHF）及慢性射血分数正常心力衰竭（HF-PSF）住院患者预后的影响。方法 前瞻性分析武汉地区4家三级甲等教学医院848例心力衰竭（简称心衰）患者,根据左室射血分数分为CSHF组（n=560）、HFPSF组（n=288）。 每组根据有无房颤又分为房颤与非房颤亚组。 单因素Kaplan-Meier曲线分别分析CSHF和HFPSF患者房颤亚组和非房颤亚组总死亡 、 心脏泵功能衰竭死亡（心衰死亡）、 心源性猝死和栓塞相关死亡的差异 。多因素Cox风险比例模型分别比较CSHF和HFPSF患者房颤亚组与非房颤亚组不同预后的差异。 结果 单因素分析发现, CSHF和HFPSF组房颤亚组与非房颤亚组总死亡无差异。CSHF组中与非房颤亚组（n=374）相比,房颤亚组（n = 186）心衰死亡增高（P = 0. 01）、栓塞相关死亡增加（P0.05）。 多因素Cox风险比例模型分析发现房颤增加CSHF患者栓塞相关死亡风险（HR = 2. 106,95% CI：1. 436 - 2.719,P〈0. 01）。 结论 房颤对CSHF和HFPSF患者预后的影响存在差异,仅增加CSHF患者栓塞相关死亡风险。房颤影响CSHF患者预后的原因可能不在于心律失常本身而在于其并发症。     

射血分数正常的心力衰竭的研究进展

通常也称心力衰竭正常的心存在许多射血分数正常的心力衰竭（heart failure with a normal ejection fraction。HFNEF）．为舒张性心力衰竭,ESC2008年的心力衰竭指南中建议称其为左室射血分数保留的（heart failure with preserved ejection fraction,HF—PEF）,目前尚缺乏针对射血分数力衰竭的公认诊断标准及最适治疗方案。在HFNEF的发病机制乃至诊疗过程中仍问题,有待我们进一步探索。     

射血分数正常的心力衰竭的研究进展

射血分数正常的心力衰竭(heart failure with a normal ejection fraction,HFNEF),通常也称为舒张性心力衰竭,ESC2008年的心力衰竭指南中建议称其为左室射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HF-PEF),目前尚缺乏针对射血分数正常的心力衰竭的公认诊断标准及最适治疗方案.在HFNEF的发病机制乃至诊疗过程中仍存在许多问题,有待我们进一步探索.     

Role of gender in heart failure with normal left ventricular ejection fraction

Heart failure with normal ejection fraction (HF-NEF) is frequently believed to be more common in women than in men. However, the interaction of gender and age has rarely been analyzed in detail, and knowledge of the distinction between pre- and postmenopausal women is lacking. Some of the studies that have described a higher prevalence of HF-NEF in women relied on clinical diagnoses of HF together with normal systolic function and did not measure diastolic function. This applies to the analysis of patients hospitalized for HF and some epidemiological investigations that agree on the greater prevalence of HF-NEF in women. Population-based studies with echocardiographic determination of diastolic function have suggested equal or greater prevalence of diastolic dysfunction in men. Major risk factors for HF-NEF include hypertension, aging, obesity, diabetes, and ischemia. Hypertension is more frequent in women and can contribute to left ventricular and arterial stiffening in a gender-specific way. Aging, obesity, and diabetes affect myocardial and vascular stiffness differently and lead to different forms of myocardial hypertrophy in women and men. In contrast, ischemia may play a greater role in men. Gender differences in ventricular diastolic distensibility, in vascular stiffness and ventricular/vascular coupling, in skeletal muscle adaptation to HF, and in the perception of symptoms may contribute to a greater rate of HF-NEF in women. The underlying molecular mechanisms include gender differences in calcium handling, in the NO system, and in natriuretic peptides. Estrogen affects collagen synthesis and degradation and inhibits the renin-angiotensin system. Effects of estrogen may provide benefit to premenopausal women, and the loss of its protective mechanisms may render the heart of postmenopausal women more vulnerable. Thus, a number of molecular mechanisms can contribute to the gender differences in HF-NEF.     

射血分数正常心力衰竭患者241例临床分析

目的：对比分析心力衰竭（HF）患者中左心室射血分数正常者（HFNEF）与射血分数降低（SHF）患者的临床和心脏结构的特点。方法：选择我院心内科连续收治,符合研究条件者共241例,其中HFNEF88例,SHF153例,分析其病因、心脏结构特点和HF危险因素。结果：与SHF患者相比,HFNEF患者的年龄较大[（75．43±10．43）岁比（80．25±7．74）岁],女性患者较多（占78．4％）,P均〈0．001。HFNEF患者的直接病因以高血压病（33．0％）、冠心病（25．0％）最多见,SHF患者的最常见病因为冠心病,尤其是陈旧性心肌梗死患者。HF—NEF患者中心房颤动的患病率较高,左心室肥厚多见（P均〈0．001）,但左心室重构的程度较轻;SHF患者血清N末端脑钠肽前体水平显著降低（P〈0．001）,肌酐水平亦降低（P〈0．05）。结论：心力衰竭左心室射血分数正常患者多为老年女性,主要病因中以高血压和冠心病最多,左室肥厚和房颤的患病率高。     

有关左心室射血分数正常的心力衰竭

心力衰竭发病率高,5年存活率与恶性肿瘤相仿,正在成为21世纪最重要的心血管疾病之一.由于超声心动图技术的发展和普及,1984年有学者首次报道1组左心室收缩功能正常的充血性心力衰竭患者.     

Diastolic heart failure or heart failure with a normal ejection fraction

Nearly half of patients with symptoms of heart failure are found to have an left ventricular (LV) ejection fraction which is within normal limits. These patients have variously been labeled as having diastolic heart failure, heart failure with preserved LV function or heart failure with normal ejection fraction (HFNEF). Since recent studies have shown that systolic function is not entirely normal in these patients, HFNEF is the better term. More common in elderly females it has a mortality similar to heart failure with a reduced ejection fraction (HFREF). The exact pathophysiology of the symtpoms is still not clear and, therefore, debated. As heart failure is often episodic, the underlying abnormal mechanisms may not be completely apparent at rest. It is likely there is a mixture of systolic and diastolic dysfunction which will be different to some degree in individual patients and isolated diastolic dysfunction or primary abnormalities of relaxation are probably extremely rare. The main difference between HFNEF and HFREF is the degree of ventricular remodeling with increased ventricular volumes in HFREF. The time course of remodeling depends to some extent on the aetiology being quicker post myocardial infarction--the commonest cause of HFREF, and slower with hypertension which is the most frequent aetiological factor in HFNEF. Ventricular volumes rather than ejection fraction or the concept of a pure diastolic abnormality can be used to classify patients in a more rational manner.     

Treatment of heart failure with a normal ejection fraction

Opinion statement Treatment of diastolic heart failure is divided into acute and chronic management. During acute management, the focus should be treatment of the presenting syndrome, including correction of volume overload, treating hypertension, alleviating ischemia, and controlling tachyarrhythmias. Therefore, acute treatment should include several components: treating volume overload with sodium restriction and diuretics; treating ischemie heart disease with antiplatelet therapy, anticoagulants, and β blockers; treating hypertension aggressively, using multiple agents if necessary; and treating atrial tachyarrhythmias such as atrial fibrillation with rate-controlling agents, such as β blockers and possibly nondihydropyridine calcium channel blockers such as diltiazem and verapamil. Antiarrhythmic agents with or without electrical cardioversion may be necessary. Thoroughly evaluate and manage extracardiac precipitants such as anemia and renal failure. Chronic management should also focus on precipitating factors, for which adequate control of hypertension is paramount. Patient education regarding dietary and medication compliance and lifestyle changes is also important. If ischemic heart disease is present, aggressive anti-ischemic therapy is necessary, including revascularization when indicated.