Nielsen Gerlach Claire L, Rutten Frans H, Mosterd Arend
HagaZiekenhuis, afd. Cardiologie, Den Haag.
Contact: Claire L. Nielsen Gerlach (
Ned Tijdschr Geneeskd. 2022 Nov 22;166:D6741.
Heart failure is a chronic illness with a high prevalence and mortality rate. The aim of this article is to give an update on new treatment options for heart failure and the value of the left ventricular ejection fraction (LVEF) in the diagnosis and treatment of heart failure. Based on LVEF, three groups of heart failure can be distinguished: (1) heart failure with reduced ejection fraction (HFrEF; LVEF ≤ 40%), (2) heart failure with mildly reduced ejection fraction (HFmrEF; LVEF 41-49%) and (3) heart failure with preserved ejection fraction (HFpEF; LVEF ≥ 50%). The treatment of HFrEF consists of four pillars, the application of which leads to symptom reduction and better survival: (1) angiotensin converting enzyme inhibitor (ACE-i) or angiotensin receptor-neprilysin inhibitor (ARNI), (2) β-blocker, (3) mineralocorticoid receptor antagonist (MRA) and (4) sodium-glucose co-transporter 2 (SGLT2) inhibitor. ACE-I, β-blocker and MRA can be considered as treatment of HFmrEF. The treatment of HFpEF mainly focuses on symptom reduction.
心力衰竭是一种患病率和死亡率都很高的慢性疾病。本文的目的是介绍心力衰竭新的治疗选择以及左心室射血分数（LVEF）在心力衰竭诊断和治疗中的价值。根据LVEF，可将心力衰竭分为三组：（1）射血分数降低的心力衰竭（HFrEF；LVEF≤40%），（2）射血分数轻度降低的心力衰竭（HFmrEF；LVEF 41-49%）和（3）射血分数保留的心力衰竭（HFpEF；LVEF≥50%）。HFrEF的治疗包括四个支柱，应用这些支柱可减轻症状并提高生存率：（1）血管紧张素转换酶抑制剂（ACE-i）或血管紧张素受体脑啡肽酶抑制剂（ARNI），（2）β受体阻滞剂，（3）盐皮质激素受体拮抗剂（MRA）和（4）钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂。ACE-I、β受体阻滞剂和MRA可被视为HFmrEF的治疗方法。HFpEF的治疗主要侧重于减轻症状。
