Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY.
John T Milliken Department of Medicine, Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant, Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine, Mo.
Am J Med. 2023 May;136(5):422-431. doi: 10.1016/j.amjmed.2023.01.024. Epub 2023 Feb 3.
Heart failure with reduced ejection fraction is a significant driver of morbidity and mortality. There are common misconceptions regarding the disease processes underlying heart failure and best practices for therapy. The terms heart failure with reduced ejection fraction and left ventricular systolic dysfunction are not interchangeable terms. Key therapies for heart failure with reduced ejection fraction target the underlying disease processes, not the left ventricular ejection fraction alone. The absence of congestion does not rule out heart failure. Patients with cardiac amyloidosis can also present with heart failure with reduced ejection fraction. A rise in serum creatinine in acute heart failure exacerbation is not associated with tubular injury. Guideline directed medical therapy should be continued during acute exacerbations of heart failure with reduced ejection fraction and should be started in the same hospitalization in new diagnoses. Marginal blood pressure is not a relative contraindication to optimal guideline directed medical therapy. Guideline directed medical therapy should be continued even if ejection fraction improves. There are other therapies that provide significant benefit besides the four key medications in guideline directed medical therapy.
射血分数降低的心力衰竭是发病率和死亡率的重要驱动因素。对于心力衰竭的潜在疾病过程和最佳治疗方法，存在一些常见的误解。射血分数降低的心力衰竭和左心室收缩功能障碍这两个术语不是可互换的术语。射血分数降低的心力衰竭的关键治疗方法针对的是潜在的疾病过程，而不仅仅是左心室射血分数。没有充血并不排除心力衰竭。心脏淀粉样变性患者也可能表现为射血分数降低的心力衰竭。急性心力衰竭加重时血清肌酐升高与肾小管损伤无关。射血分数降低的心力衰竭急性加重期间应继续进行指南指导的药物治疗，并应在新诊断的同一住院期间开始治疗。血压边缘不是最佳指南指导药物治疗的相对禁忌症。即使射血分数改善，也应继续进行指南指导的药物治疗。除了指南指导的药物治疗中的四种关键药物外，还有其他提供显著益处的治疗方法。
