Tadic Marijana, Pieske-Kraigher Elisabeth, Cuspidi Cesare, Genger Martin, Morris Daniel A, Zhang Kun, Walther Nina Alexandra, Pieske Burket
Department of Cardiology, Charité-University Medicine Berlin, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.
University of Milano-Bicocca, Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, 20036, Meda, Italy.
Heart Fail Rev. 2017 May;22(3):371-379. doi: 10.1007/s10741-017-9618-3.
Despite the high prevalence of the patients with heart failure with preserved ejection fraction (HFpEF), our knowledge about this entity, from diagnostic tools to therapeutic approach, is still not well established. The evaluation of patients with HFpEF is mainly based on echocardiography, as the most widely accepted tool in cardiac imaging. Identification of left ventricular (LV) diastolic dysfunction has long been considered as the only responsible for HFpEF, and its evaluation is still "sine qua non" of HFpEF diagnostics. However, one should be aware of the fact that identifying cardiac dysfunction in HFpEF might be very challenging and often needs more complex evaluation of cardiac structure and function. New echocardiographic modalities such as 2D and 3D speckle tracking imaging could help in the diagnosis of HFpEF and provide further information regarding LV function and mechanics. Early diagnosis, medical management, and adequate monitoring of HFpEF patients are prerequisites of modern medical treatment. New healthcare approaches require individualized patient care, which is why clinicians should have all clinical, laboratory, and diagnostic data before making final decisions about the treatment of any patients. This is particularly important for HFpEF that often remains undiagnosed for quite a long time, which further prolongs the beginning of adequate treatment and brings into question outcome of these patients. The aim of this article is to provide the overview of the main principles of LV mechanics and summarize recent data regarding LV strain in patients with HFpEF.
尽管射血分数保留的心力衰竭（HFpEF）患者患病率很高，但我们对这一病症的了解，从诊断工具到治疗方法，仍未完全确立。HFpEF患者的评估主要基于超声心动图，这是心脏成像中最广泛接受的工具。左心室（LV）舒张功能障碍的识别长期以来一直被认为是HFpEF的唯一病因，其评估仍然是HFpEF诊断的“必要条件”。然而，应该意识到，识别HFpEF中的心脏功能障碍可能非常具有挑战性，通常需要对心脏结构和功能进行更复杂的评估。新的超声心动图模式，如二维和三维斑点追踪成像，有助于HFpEF的诊断，并提供有关左心室功能和力学的进一步信息。HFpEF患者的早期诊断、药物治疗和充分监测是现代医学治疗的先决条件。新的医疗保健方法需要个性化的患者护理，这就是为什么临床医生在对任何患者的治疗做出最终决定之前应掌握所有临床、实验室和诊断数据。这对于HFpEF尤为重要，因为HFpEF往往很长时间都未被诊断出来，这进一步延长了适当治疗的开始时间，并使这些患者的预后受到质疑。本文的目的是概述左心室力学的主要原理，并总结有关HFpEF患者左心室应变的最新数据。
