Goldsmith S R, Dick C
Hennepin County Medical Center, University of Minnesota, Minneapolis 55415.
Am J Med. 1993 Dec;95(6):645-55. doi: 10.1016/0002-9343(93)90361-r.
To compare and contrast the pathophysiology and therapy of heart failure with normal and abnormal systolic ventricular function.
Review of basic pathophysiologic mechanisms, clinical data, and therapeutic trials.
The clinical features of heart failure may be similar regardless of whether ventricular function is normal or abnormal. However, the pathophysiologic mechanisms leading to heart failure with normal ventricular function differ considerably from those producing heart failure with abnormal systolic function. The key problems in heart failure with abnormal systolic function involve impaired contractility, neuroendocrine activation, increased intracardiac volume and pressure, and enhanced sensitivity to change in afterload. With normal systolic function, the key problem is an abnormal diastolic pressure/volume relationship, which may be due to a variety of active and passive processes affecting diastole. Assessing left ventricular systolic function is crucial before initiating therapy in a patient with heart failure, since treatment for systolic dysfunction may be ineffective or even counterproductive if symptoms are due to abnormal diastolic properties with preserved systolic function.
比较和对比收缩功能正常及异常的心力衰竭的病理生理学和治疗方法。
回顾基本病理生理机制、临床数据及治疗试验。
无论心室功能正常与否，心力衰竭的临床特征可能相似。然而，导致收缩功能正常的心力衰竭的病理生理机制与导致收缩功能异常的心力衰竭的机制有很大差异。收缩功能异常的心力衰竭的关键问题包括收缩力受损、神经内分泌激活、心腔内容积和压力增加以及对后负荷变化的敏感性增强。在收缩功能正常时，关键问题是舒张期压力/容积关系异常，这可能是由于多种影响舒张期的主动和被动过程所致。在对心力衰竭患者开始治疗前评估左心室收缩功能至关重要，因为如果症状是由于收缩功能保留但舒张特性异常所致，针对收缩功能障碍的治疗可能无效甚至适得其反。
