舒张性心力衰竭诊断和治疗专家共识

An expert consensus for diagnosis and treatment of diastolic heart failure

心力衰竭(心衰)是一种异质性很强的复杂临床综合征,根据左室射血分数对心衰进行分类简便易行,但存在局限性。收缩性心衰(SHF)与舒张性心衰(DHF)病理生理机制不同,SHF应用神经激素拮抗剂治疗显著获益,DHF病理生理机制涉及系统性炎症、代谢紊乱、心外膜脂肪组织堆积、心肌微血管功能障碍、心肌纤维化等,DHF的有效治疗尚未明确。DHF诊断建议采用超声心动图提出的心功能诊断标准。目前DHF治疗策略包括对症治疗、探索性抗炎症和抗代谢药物治疗。为了减少心衰再住院率,神经激素拮抗剂适用于大多数SHF合并DHF患者的治疗。

Heart failure(HF)is a complex clinical syndrome with high heterogenity,so the traditional classification of this disease,depending on left ventricular ejection fraction,might have some limitations,although it is easy to carry out.Nowadays,growing evidences showed that the underlying pathophysiological mechanism of diastolic heart failure(DHF)was probably differed from systolic heart failure(SHF).Neurohormone antagonists presented uncertain effects on DHF instead of remarkable efficacy in SHF patients.Various factors,including systemic inflammatory responses,metabolic disorders,epicardial adipose tissue accumulation,myocardial fibrosis,were currently indicated to participate in the development of DHF.It is recommended that the evaluation parameters of diastolic function by echocardiography are critical criteria for diagnosis of DHF.The treatment of DHF needs further exploration,especially in anti-inflammatory and antimetabolite agents,except for some symtomatic treatments.The neurohormone antagonists could be used for SHF combined with DHF patients to reduce their HF readmission rates.