Rosano Giuseppe M C, Teerlink John R, Kinugawa Koichiro, Bayes-Genis Antoni, Chioncel Ovidiu, Fang James, Greenberg Barry, Ibrahim Nasrien E, Imamura Teruhiko, Inomata Takayuki, Kuwahara Koichiro, Moura Brenda, Onwuanyi Anekwe, Sato Naoki, Savarese Gianluigi, Sakata Yasuhiko, Sweitzer Nancy, Wilcox Jane, Yamamoto Kazuhiro, Metra Marco, Coats Andrew J S
San Raffaele Open University of Rome, Rome, Italy; Cardiology, San Raffaele Cassino Hospital, Cassino, Italy.
University of California San Francisco, San Francisco, CA, USA.
J Card Fail. 2025 Apr 9. doi: 10.1016/j.cardfail.2025.03.014.
This clinical consensus statement revisits the role of left ventricular ejection fraction (LVEF) as a measurement of cardiac function, a prognostic marker and a major criterion to classify patients with heart failure, and gives new advice for clinical practice. Heart failure is traditionally classified on the basis of LVEF thresholds and this has major implications for treatment recommendations. However, the reproducibility of LVEF measurement is poor and its prognostic and diagnostic value lessens when it is above 45%, with no relationship with the severity of either cardiac dysfunction or outcomes at higher values. These limitations dictate the need for a more comprehensive approach to classify and assess heart failure focusing more on the trajectory of LVEF rather than to its absolute value. Furthermore, the assessment of LVEF is not required for the initiation of treatments like sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists and diuretics in patients with suspected de novo heart failure and elevated N-terminal pro-B-type natriuretic peptide levels. Future research utilizing advanced imaging techniques and biomarkers which can better characterize myocardial structure, metabolism and performance may facilitate the identification of alternative therapeutic targets and better ways to monitor heart failure therapies across the entire spectrum of LVEF.
本临床共识声明重新审视了左心室射血分数（LVEF）作为心脏功能测量指标、预后标志物以及心力衰竭患者分类主要标准的作用，并为临床实践提供了新建议。传统上，心力衰竭是根据LVEF阈值进行分类的，这对治疗建议有重大影响。然而，LVEF测量的可重复性较差，当LVEF高于45%时，其预后和诊断价值会降低，在较高值时与心脏功能障碍的严重程度或预后均无关联。这些局限性表明需要一种更全面的方法来对心力衰竭进行分类和评估，更多地关注LVEF的变化轨迹而非其绝对值。此外，对于疑似新发心力衰竭且N末端B型利钠肽原水平升高的患者，在开始使用钠-葡萄糖协同转运蛋白2抑制剂、盐皮质激素受体拮抗剂和利尿剂等治疗时，无需评估LVEF。未来利用先进成像技术和生物标志物进行的研究，能够更好地表征心肌结构、代谢和功能，这可能有助于确定替代治疗靶点，并找到在整个LVEF范围内监测心力衰竭治疗的更好方法。
