Fonarow G C
Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, UCLA School of Medicine, Los Angeles, CA, USA.
Rev Cardiovasc Med. 2001;2 Suppl 2:S7-S12.
Acute decompensated heart failure is characterized by hemodynamic abnormalities as well as neuroendocrine activation, which contribute to heart failure symptoms, progressive cardiac dysfunction, and sudden death. The therapeutic goals in patients hospitalized with decompensated heart failure are to reverse acute hemodynamic abnormalities, relieve symptoms, and initiate treatment that will slow disease progression and improve long-term survival. Traditional hemodynamic targets in acute heart failure have been reduction in left and right ventricular filling pressures, reduction in systemic vascular resistance, and increase in cardiac output. Treatments aimed at these targets in patients with acute decompensated heart failure include diuretics, vasodilators, and inotropic agents. In patients hospitalized with acute decompensated heart failure, persistently elevated left ventricular filling pressure has been shown to be highly predictive of an increased risk of fatal decompensation and sudden death. Measures of systemic perfusion, arterial pressure, and vascular resistance have not. Thus, there is a more compelling physiologic rationale for the use of vasodilators than for inotropic agents in these patients. An ideal agent for acute decompensated heart failure would be one that rapidly reduces pulmonary wedge pressure, results in balanced arterial and venous dilation, promotes natriuresis, lacks direct positive inotropic effects, and does not result in reflex neuroendocrine activation.
急性失代偿性心力衰竭的特征是血流动力学异常以及神经内分泌激活，这些因素导致心力衰竭症状、进行性心脏功能障碍和猝死。因失代偿性心力衰竭住院患者的治疗目标是逆转急性血流动力学异常、缓解症状，并启动能减缓疾病进展和改善长期生存率的治疗。急性心力衰竭的传统血流动力学目标是降低左、右心室充盈压，降低体循环血管阻力，并增加心输出量。针对急性失代偿性心力衰竭患者这些目标的治疗方法包括利尿剂、血管扩张剂和正性肌力药物。在因急性失代偿性心力衰竭住院的患者中，左心室充盈压持续升高已被证明是致命性失代偿和猝死风险增加的高度预测指标。而体循环灌注、动脉压和血管阻力的指标则并非如此。因此，在这些患者中使用血管扩张剂比使用正性肌力药物有更令人信服的生理学依据。一种理想的急性失代偿性心力衰竭药物应该是能迅速降低肺楔压、导致动脉和静脉平衡扩张、促进利钠、缺乏直接正性肌力作用且不会导致反射性神经内分泌激活的药物。
