Bader Feras M, Attallah Nizar
Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Curr Opin Cardiol. 2017 Mar;32(2):203-208. doi: 10.1097/HCO.0000000000000378.
Acute decompensated heart failure (ADHF) is one of the biggest challenges in the management of chronic heart failure. Despite the advances in medical and device therapy, high readmission and mortality rates continue to be a burden on healthcare systems worldwide. One of the strongest predictors of adverse outcomes in ADHF is renal dysfunction, referred to as cardiorenal syndrome (CRS) type 1. This review discusses some of the recently introduced findings related to the pathophysiology, diagnosis, and management of this disorder.
There is a better understanding of the pathophysiology of ADHF and CRS. Systemic and intrarenal hemodynamic data provided a much deeper insight into various mechanisms of interaction between the heart and the kidney. Novel biomarkers have been discovered and developed recently to help diagnose and predict prognosis of CRS. Although there was optimism toward using ultrafiltration in treating ADHF with CRS, recent data did not support that, and management remains primarily driven by reversing ADHF hemodynamic and neurohormonal derangements.
ADHF with CRS carries poor prognosis and high mortality. There is a need for individual risk assessment and management. A dedicated experienced multidisciplinary team is needed to diagnose and manage patients with this problem. Different approaches are needed to address the complex elements of this disorder.
急性失代偿性心力衰竭（ADHF）是慢性心力衰竭管理中面临的最大挑战之一。尽管在药物和器械治疗方面取得了进展，但高再入院率和死亡率仍然是全球医疗系统的负担。ADHF不良结局的最强预测因素之一是肾功能不全，即1型心肾综合征（CRS）。本综述讨论了一些最近报道的与该疾病病理生理学、诊断和管理相关的研究结果。
对ADHF和CRS的病理生理学有了更好的理解。全身和肾内血流动力学数据为深入了解心脏和肾脏之间的各种相互作用机制提供了更多信息。最近发现并开发了新型生物标志物，以帮助诊断和预测CRS的预后。尽管曾对使用超滤治疗合并CRS的ADHF抱有乐观态度，但最近的数据并不支持这一点，治疗仍主要通过纠正ADHF的血流动力学和神经激素紊乱来进行。
合并CRS的ADHF预后差、死亡率高。需要进行个体风险评估和管理。需要一个专业的、经验丰富的多学科团队来诊断和管理患有该疾病的患者。需要采用不同的方法来应对该疾病的复杂因素。
