Harada Tomonari, Kagami Kazuki, Kato Toshimitsu, Ishii Hideki, Obokata Masaru
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan.
Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa 359-8513, Saitama, Japan.
J Cardiovasc Dev Dis. 2022 Mar 17;9(3):87. doi: 10.3390/jcdd9030087.
More than half of patients with heart failure have a preserved ejection fraction (HFpEF). The prevalence of HFpEF has been increasing worldwide and is expected to increase further, making it an important health-care problem. The diagnosis of HFpEF is straightforward in the presence of obvious objective signs of congestion; however, it is challenging in patients presenting with a low degree of congestion because abnormal elevation in intracardiac pressures may occur only during physiological stress conditions, such as during exercise. On the basis of this hemodynamic background, current consensus guidelines have emphasized the importance of exercise stress testing to reveal abnormalities during exercise, and exercise stress echocardiography (i.e., diastolic stress echocardiography) may be used as an initial diagnostic approach to HFpEF owing to its noninvasive nature and wide availability. However, evidence supporting the use of this method remains limited and many knowledge gaps exist with respect to diastolic stress echocardiography. This review summarizes the current understanding of the use of diastolic stress echocardiography in the diagnostic evaluation of HFpEF and discusses its strengths and limitations to encourage future studies on this subject.
超过半数的心力衰竭患者射血分数保留（HFpEF）。HFpEF的患病率在全球范围内一直在上升，预计还会进一步增加，这使其成为一个重要的医疗问题。在存在明显的充血客观体征时，HFpEF的诊断很简单；然而，对于充血程度较低的患者，诊断具有挑战性，因为心内压异常升高可能仅在生理应激状态下出现，如运动时。基于这种血流动力学背景，当前的共识指南强调了运动负荷试验对于揭示运动期间异常情况的重要性，并且运动负荷超声心动图（即舒张期负荷超声心动图）因其非侵入性和广泛可用性，可作为HFpEF的初始诊断方法。然而，支持使用该方法的证据仍然有限，并且在舒张期负荷超声心动图方面存在许多知识空白。本综述总结了目前对舒张期负荷超声心动图在HFpEF诊断评估中的应用的理解，并讨论其优点和局限性，以鼓励未来对该主题的研究。
