射血分数保留心力衰竭患者右心室功能障碍的研究进展

Research Advances in Right Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction

在射血分数减低心力衰竭(HFrEF)中,右心室功能障碍(right ventricular dysfunction,RVD)已被广泛证实和认识,但在射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)中,RVD还未被广泛关注和描述。近年来,研究表明RVD在HFpEF中所占比例较高,而且与心力衰竭不良预后独立相关。此外,肺动脉高压及心房颤动、2型糖尿病、高血压、冠心病等多个合并症是RVD的致病或促进因素,也与心力衰竭临床预后不良相关。同时,认识右心与左心之间的相互作用关系对RVD的进一步理解至关重要。本文就HFpEF患者,RVD的患病率、RVD与多个合并症及与左心之间的关系等方面进行综述,以期通过对HFpEF患者右心室功能进行评估为临床干预和治疗决策提供指导。

Right ventricular dysfunction(RVD)has been widely confirmed and recognized in heart failure with reduced ejection fraction(HFrEF),but it has not been paid much attention and made description in heart failure with preserved ejection fraction(HFpEF).Studies in recent years have shown that RVD accounts for a large proportion of HFpEF and is independently associated with poor prognosis in heart failure.In addition,comorbidities such as pulmonary hypertension and atrial fibrillation,type 2 diabetes,hypertension and coronary heart disease are pathogenic or contributing factors of RVD,and are also associated with poor clinical prognosis of heart failure.Meanwhile,improved recognization of the interaction between the right and left ventricular is crucial to further understand RVD.This article reviews the prevalence of RVD and the relationship between RVD and multiple comorbidities and the left ventricular in HFpEF,in order to provide guidance for clinical intervention and treatment decision-making though the assessment of right ventricular function in patients with HFpEF.