Mathew Sunil T, Gottdiener John S, Kitzman Dalane, Aurigemma Gerard
Division of Cardiology, St. Francis Hospital, State University of New York at Stony Brook, Roslyn, NY 11576, USA.
Am J Geriatr Cardiol. 2004 Mar-Apr;13(2):61-8. doi: 10.1111/j.1076-7460.2004.02121.x.
Congestive heart failure in the elderly is recognized as a national public health priority; however, clinical diagnosis can be problematic in elderly persons, many of whom have a history of heart failure in the presence of normal or only minimally decreased ejection fraction. Findings of the Cardiovascular Health Study have underscored the common substrate and predictors underlying heart failure both with decreased ejection fraction and with normal ejection fraction (i.e., diastolic heart failure). Coronary heart disease, systolic blood pressure, and C-reactive protein (a measure of inflammation) are predictive of heart failure independent of ejection fraction. Left atrial size, arguably a marker of the effects of impaired diastolic filling over time, is increased in both systolic and diastolic heart failure of the elderly, as is atrial natriuretic peptide. The outcome of heart failure in elderly persons is poor both for systolic and diastolic heart failure. Moreover, many community-dwelling elderly persons have decreased ejection fraction without heart failure. In these persons the chance of death is similar to that of participants with diastolic heart failure. Since most clinical trials have studied younger patients with predominantly systolic heart failure, the appropriate therapy for heart failure in elderly persons remains to be determined.
老年人充血性心力衰竭被视为国家公共卫生重点问题；然而，临床诊断在老年人中可能存在问题，他们中的许多人在射血分数正常或仅轻微降低的情况下就有心力衰竭病史。心血管健康研究的结果强调了射血分数降低型心力衰竭和射血分数正常型心力衰竭（即舒张性心力衰竭）背后的共同基础和预测因素。冠心病、收缩压和C反应蛋白（一种炎症指标）可独立于射血分数预测心力衰竭。左心房大小可以说是随着时间推移舒张期充盈受损影响的一个标志，在老年人的收缩性和舒张性心力衰竭中均会增大，心房利钠肽也是如此。老年人收缩性和舒张性心力衰竭的预后都很差。此外，许多居家老年人射血分数降低但无心力衰竭。在这些人中，死亡几率与舒张性心力衰竭患者相似。由于大多数临床试验研究的是主要患有收缩性心力衰竭的年轻患者，老年人心力衰竭的适当治疗方法仍有待确定。
