Iyngkaran Pupalan, Anavekar Nagesh S, Neil Christopher, Thomas Liza, Hare David L
Department of Medicine, Northern Territory Medical School, Flinders University, Charles Darwin University Campus, Casuarina, NT 0815, Australia.
Department of Cardiology, Northern Hospital, Northern Health, University of Melbourne, Melbourne, VIC 3076, Australia.
World J Methodol. 2017 Dec 26;7(4):117-128. doi: 10.5662/wjm.v7.i4.117.
The symptom cluster of shortness of breath (SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.
呼吸急促（SOB）症状群显著增加了心脏病门诊服务的工作量。对这些患者的检查包括血液化学和生物标志物、心脏和肺部的影像学及功能测试。通过排除收缩期异常、正常的肺功能测试和正常的血红蛋白，并结合超声心动图显示的舒张期异常来推断舒张性心力衰竭的诊断。在舒张期异常的患者中区分肥胖或身体机能下降等混杂因素很困难。虽然最新指南提供了更多诊断途径，如纳入左心房大小，但很少强调了解左心房功能，而左心房功能至少占舒张期左心室充盈的25%；此外，在缺乏“金标准”侵入性检查时，通过运动负荷试验引发症状并测试舒张期参数的动态变化，存在临床转化差距。因此，在舒张性心力衰竭的检查中，了解左心房力学和运动试验的作用对于为出现呼吸急促的患者诊断舒张性心力衰竭构建全面论据很重要。
