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[AHA2012]HFPEF的诊断与治疗——布莱根妇女医院Eldrin Lewis教授专访
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作者:E.Lewis 编辑:国际循环网 时间:2012/11/8 14:09:24 关键字:射血分数 阵发性呼吸困难 肥胖 

  International Circulation: Dr. Solomon presented many tools for the diagnosis of heart failure with preserved ejection fraction (HFpEF), but many seemed to have flaws. Would you have any tips for cardiologists attempting to diagnose HFpEF?
 Dr. Eldrin Lewis: I think much of it starts with the signs and symptoms. Using the Framingham HF score is the best place to start. If they have paroxysmal nocturnal dyspnea?and orthopnea, those are relatively specific symptoms of heart failure. Many of the others are not. Dyspnea and exertion can be caused by countless variables, but if they have orthopnea or paroxysmal nocturnal dyspnea, plus other major criteria for heart, then physicians can feel more certain. It would be nice to have some comfirmatory data, including the BNP. If the BNP is elevated or evidence of diastolic dysfunction in an echo cardiogram, or if you have other structural abnormalities in imaging, that would also add support.
《国际循环》:Solomon医生提出了许多工具来诊断正常射血分数的心脏衰竭(HFpEF),但是许多方法似乎都有缺陷。在尝试诊断HfpEF方面,您能给心脏科医生提供一些窍门吗?
 Eldrin Lewis教授:我认为大部分HFpEF开始都是有症状或体征的。开始最好使用Framingham心衰得分进行诊断。如果他们有阵发性夜间呼吸困难和端坐呼吸就可以说明他们是HFpEF,因为这些都是HFpEF的典型症状。而许多其他症状则并不典型。引起阵发性呼吸困难的因素不计其数,但如果他们有端坐呼吸或阵发性夜间呼吸困难,加上其他主要指标,医生就可以更加确定是HFpEF。如果有一些更确凿的数据就更好了,包括BNP。如果BNP升高或心电图回声显示心脏舒张功能异常,或者如果造影显示有其他的结构异常,这些都会增加我们对HFpEF判断的确定性。
International Circulation: As many of the methods used for treatment of HFpEF fail, such as ACE-inhibitors and ARBs, does this suggest that there may be a different underlying mechanism to HFpEF?
Dr. Eldrin Lewis: I believe part of this is making sure that we have defined the population, because the if the enrollment criteria is loose. Let us say I am an investigator who wants a patient enrolled in a trial, I can include those whose EF is normal and are short of breath. However, they can be short of breath for a variety of reasons. Having more precision with the patient population will enable us to test the question. I think the other issue is that the trials were underpowered. Since the event rate in lower, one needs more patients to see if there is a true benefit.
《国际循环》:我们用于治疗HfpEF的很多方法都失败了,如ACE-inhibitors和ARBs药物,这是否表明HFpEF的深层机制可能有所不同?
Eldrin Lewis教授:我相信即使定义HFpEF患者人群的标准失效,那么也会因为这些方法的失败帮助我们更好地确定HFpEF的人群。如果说我是一个临床研究员,我想要一个患者参与试验,我可以将那些呼吸短促但是EF正常的患者包括在内。然而,他们的呼吸短促可以是出于多种原因。有更精确的患者人群我们才能够检测到正真的问题所在。我认为另一个问题是,这些试验动力不足。因为试验结果成功率低,我们就需要更多的病人来验证试验是否真正有效。



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