Federmann M, Risti B, Hess O M
Departement für Innere Medizin, Kardiologie, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1994 Jul 2;124(26):1196-202.
Left ventricular failure has been subdivided into different forms. Systolic pump failure (= systolic dysfunction) and diastolic filling failure (= diastolic dysfunction) are important entities in the overall framework of heart failure. The clinical patterns of both are presented in light of 2 case reports: systolic dysfunction involves the combination of left ventricular failure, cardiomegaly and depressed systolic ejection fraction. Diastolic dysfunction is accompanied by pulmonary congestion in the presence of a normal or only slightly enlarged ventricle and a normal ejection fraction. Prognosis of systolic dysfunction is poor, with a 5-year survival rate of 40%, compared to 70% in patients with isolated diastolic dysfunction. Medical treatment of systolic dysfunction is based primarily on ACE-inhibitors followed by diuretics and digitalis. Betablockers in low doses and spironolactone can provide additional benefit. Calcium channel blockers are rarely indicated, due to their negative inotropic effects. In patients with diastolic dysfunction, however, they are the first choice because of their positive lusitropic effect on relaxation and ventricular filling. ACE-inhibitors are suitable in hypertensive heart disease, while diuretics and betablockers are second line drugs. Digitalis should be avoided since worsening of diastolic function may occur.
左心室衰竭已被细分为不同形式。收缩期泵衰竭（即收缩功能障碍）和舒张期充盈衰竭（即舒张功能障碍）是心力衰竭总体框架中的重要类型。结合两例病例报告阐述这两种类型的临床模式：收缩功能障碍表现为左心室衰竭、心脏扩大和收缩期射血分数降低。舒张功能障碍在心室正常或仅轻度扩大且射血分数正常的情况下伴有肺淤血。收缩功能障碍的预后较差，5年生存率为40%，而单纯舒张功能障碍患者的5年生存率为70%。收缩功能障碍的药物治疗主要基于血管紧张素转换酶抑制剂，其次是利尿剂和洋地黄。小剂量β受体阻滞剂和螺内酯可带来额外益处。由于钙通道阻滞剂具有负性肌力作用，很少使用。然而，对于舒张功能障碍患者，因其对舒张和心室充盈具有正性变时作用，是首选药物。血管紧张素转换酶抑制剂适用于高血压性心脏病，而利尿剂和β受体阻滞剂是二线药物。应避免使用洋地黄，因为可能会导致舒张功能恶化。
