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射血分数保留的心力衰竭与心房颤动:基于心力衰竭和电生理最新治疗进展的临床管理

Heart failure with preserved ejection fraction and atrial fibrillation: clinical management in the context of recent therapeutic advances in heart failure and electrophysiology.

作者信息

Yang Eunice, Rashid Haroon

机构信息

Inova Schar Heart and Vascular, Arrhythmia Division, Fairfax, VA, United States.

Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States.

出版信息

Front Cardiovasc Med. 2024 Jan 29;11:1349584. doi: 10.3389/fcvm.2024.1349584. eCollection 2024.

Abstract

Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have emerged as major age-related epidemics within cardiology. Both conditions carry overlapping symptomatology, and delineating between AF and HFpEF from a diagnostic standpoint is challenging as echocardiographic and biomarker assessments used to diagnose HFpEF may be impacted by AF. Indeed, these two conditions are commonly found in the same individual, so much so that AF has been used in proposed diagnostic criteria for HFpEF. The frequent concomitant presence of these two conditions is associated with poorer quality of life, exertional capacity, as well as increased risk for decompensated heart failure and all-cause mortality. Though these deleterious effects of AF in HFpEF patients are well described, we currently have only a superficial understanding of the complex interplay between these two conditions. Preliminary studies on intervening in AF in HFpEF are very small, with mixed data on whether modifying the natural history of AF can lead to improvement in heart failure (HF) outcomes in HFpEF. In this review, we will describe the clinical implications of carrying both cardiovascular conditions, address recent advances in HFpEF and AF, and highlight preliminary studies targeted at reduction of effects associated with AF burden in HFpEF.

摘要

射血分数保留的心力衰竭(HFpEF)和心房颤动(AF)已成为心脏病学领域中与年龄相关的主要流行病。这两种病症具有重叠的症状,从诊断角度区分AF和HFpEF具有挑战性,因为用于诊断HFpEF的超声心动图和生物标志物评估可能会受到AF的影响。事实上,这两种病症在同一个体中很常见,以至于AF已被纳入HFpEF的拟议诊断标准中。这两种病症的频繁并存与生活质量较差、运动能力下降以及失代偿性心力衰竭风险增加和全因死亡率升高有关。尽管AF对HFpEF患者的这些有害影响已得到充分描述,但我们目前对这两种病症之间复杂的相互作用只有肤浅的了解。关于干预HFpEF患者AF的初步研究规模非常小,关于改变AF的自然病程是否能改善HFpEF患者的心力衰竭(HF)结局的数据也不一致。在本综述中,我们将描述同时患有这两种心血管疾病的临床意义,阐述HFpEF和AF的最新进展,并重点介绍旨在减轻AF负担对HFpEF影响的初步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2e0/10859455/baf1e7e2f912/fcvm-11-1349584-g001.jpg

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