Morbach Caroline, Wanner Christoph, Störk Stefan
Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Am Schwarzenberg15, 97078, Würzburg, Deutschland.
Interdisziplinäres Amyloidosezentrum Nordbayern, Würzburg, Deutschland.
Inn Med (Heidelb). 2022 Jul;63(7):798-804. doi: 10.1007/s00108-022-01286-z. Epub 2022 Mar 14.
In August 2021, an update of the European Society of Cardiology-Heart Failure Association guideline for the diagnosis and treatment of heart failure was released. To review the changes implied by current guidelines regarding the diagnosis and treatment of patients with heart failure and preserved left ventricular ejection fraction (HFpEF). The diagnosis of HFpEF requires the combined presence of clinical signs, left ventricular ejection fraction ≥ 50%, elevated natriuretic peptides, and elevated left ventricular filling pressure. If the diagnosis remains equivocal, a stress test is recommended. The targeted identification and treatment of comorbid conditions is key for a holistic therapeutic approach to HFpEF. Diuretics are recommended in congested patients with HFpEF in order to alleviate signs and symptoms. The treatment of diabetic patients with heart failure should include a sodium glucose co-transporter‑2 (SGLT2) inhibitor. All patients with HFpEF should be enrolled in a multidisciplinary heart failure management program aiming to improve self-care strategies and offer participation in an exercise program. It was recently shown for the first time in a randomized trial that hard clinical endpoints could be reduced in patients with HFpEF using the SGLT2 inhibitor empagliflozin. It is expected that this finding will become part of updated treatment recommendations in the near future. Although challenging, the early diagnosis of HFpEF is key to averting the poor prognosis associated with this frequent condition. Multidisciplinary care and innovative pharmacologic and non-pharmacologic therapies, however, can improve quality of life, exercise tolerance, and prognosis.
2021年8月，欧洲心脏病学会-心力衰竭协会发布了心力衰竭诊断和治疗指南的更新版。旨在回顾当前指南中关于射血分数保留的心力衰竭（HFpEF）患者诊断和治疗的变化。HFpEF的诊断需要同时具备临床体征、左心室射血分数≥50%、利钠肽升高以及左心室充盈压升高。如果诊断仍不明确，建议进行负荷试验。针对合并症的靶向识别和治疗是HFpEF整体治疗方法的关键。对于有充血症状的HFpEF患者，建议使用利尿剂以缓解体征和症状。心力衰竭糖尿病患者的治疗应包括钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂。所有HFpEF患者都应参加多学科心力衰竭管理项目，旨在改善自我护理策略并提供参与运动项目的机会。最近在一项随机试验中首次表明，使用SGLT2抑制剂恩格列净可降低HFpEF患者的硬临床终点事件。预计这一发现将在不久的将来成为更新治疗建议的一部分。尽管具有挑战性，但HFpEF的早期诊断是避免这种常见疾病不良预后的关键。然而，多学科护理以及创新的药物和非药物疗法可以改善生活质量、运动耐量和预后。
