Casa de Saúde São José, Rio de Janeiro, Brazil.
Arq Bras Cardiol. 2012 Jan;98(1):e15-21. doi: 10.1590/s0066-782x2012000100020.
Among the cardiovascular diseases, heart failure (HF) has a high rate of hospitalization, morbidity and mortality, consuming vast resources of the public health system in Brazil and other countries. The correct determination of the filling pressures of the left ventricle by noninvasive or invasive assessment is critical to the proper treatment of patients with decompensated chronic HF, considering that congestion is the main determinant of symptoms and hospitalization. Physical examination has shown to be inadequate to predict the hemodynamic pattern. Several studies have suggested that agreement on physical findings by different physicians is small and that, ultimately, adaptive physiological alterations in chronic HF mask important aspects of the physical examination. As the clinical assessment fails to predict hemodynamic aspects and because the use of Swan-Ganz catheter is not routinely recommended for this purpose in patients with HF, noninvasive hemodynamic assessment methods, such as BNP, echocardiography and cardiographic bioimpedance, are being increasingly used. The present study intends to carry out, for the clinician, a review of the role of each of these tools when defining the hemodynamic status of patients with decompensated heart failure, aiming at a more rational and individualized treatment.
在心血管疾病中，心力衰竭（HF）的住院率、发病率和死亡率都很高，消耗了巴西和其他国家公共卫生系统的大量资源。通过非侵入性或侵入性评估正确确定左心室充盈压对于治疗失代偿性慢性 HF 患者至关重要，因为充血是症状和住院的主要决定因素。体格检查已被证明不足以预测血流动力学模式。多项研究表明，不同医生对体格检查结果的一致性较小，而慢性 HF 中的适应性生理改变最终掩盖了体格检查的重要方面。由于临床评估未能预测血流动力学方面的情况，并且由于不建议在 HF 患者中常规使用 Swan-Ganz 导管进行该目的，因此越来越多地使用非侵入性血流动力学评估方法，如 BNP、超声心动图和心阻抗图。本研究旨在为临床医生复习这些工具在确定失代偿性心力衰竭患者血流动力学状态中的作用，旨在实现更合理和个体化的治疗。
