Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete?
Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete?
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DOI：
10.1016/j.jchf.2017.09.009
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Mann DL
中科院分区：
文献类型：
--
作者：
Bristow MR;Kao DP;Breathett KK;Altman NL;Gorcsan J 3rd;Gill EA;Lowes BD;Gilbert EM;Quaife RA;Mann DL
疾病或综合征的诊断、预后、治疗和新疗法的开发取决于识别与这些不同目标的不同预测概率相关的表型的可靠方法。左心室射血分数 (LVEF) 通过将患者分为射血分数降低的心力衰竭 (HFrEF) 和射血分数保留的心力衰竭 (HFpEF) 患者，为心力衰竭的功能和结构组合表型分析提供了当前基础。最近，由于 LVEF 的负荷依赖性和测量变异性，LVEF 作为心力衰竭主要表型决定因素的实用性受到了挑战。我们回顾了 LVEF 作为 LV 功能和结构的关键测量方法的发展和采用的历史，并证明，在慢性心力衰竭中，负荷依赖性并不是一个重要的实际问题，并且我们提供了血流动力学和分子生物标志物证据，表明 LVEF 优于或等于识别心室重塑表型的更笨重的方法。我们的结论是，由于 LVEF 能够可靠地测量左心室功能和结构，因此在个体临床和多中心团体环境中，LVEF 仍然是当前评估心力衰竭病理重塑的最佳方法。由于左心室表型分析在心力衰竭中的当前和未来重要性，因此应使用最准确的技术和现有的方法学改进来测量 LVEF，并应继续寻求改进的表征方法。
Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.
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影响因子：
5.9
作者：
GRANT, C;GREENE, DG;BUNNELL, IL
通讯作者：
BUNNELL, IL
影响因子：
2.8
作者：
DODGE, HT;BAXLEY, WA
通讯作者：
BAXLEY, WA
影响因子：
37.8
作者：
ROSS, J;BRAUNWALD, E
通讯作者：
BRAUNWALD, E
影响因子：
37.8
作者：
Benjamin EJ;Blaha MJ;Chiuve SE;Cushman M;Das SR;Deo R;de Ferranti SD;Floyd J;Fornage M;Gillespie C;Isasi CR;Jiménez MC;Jordan LC;Judd SE;Lackland D;Lichtman JH;Lisabeth L;Liu S;Longenecker CT;Mackey RH;Matsushita K;Mozaffarian D;Mussolino ME;Nasir K;Neumar RW;Palaniappan L;Pandey DK;Thiagarajan RR;Reeves MJ;Ritchey M;Rodriguez CJ;Roth GA;Rosamond WD;Sasson C;Towfighi A;Tsao CW;Turner MB;Virani SS;Voeks JH;Willey JZ;Wilkins JT;Wu JH;Alger HM;Wong SS;Muntner P;American Heart Association Statistics Committee and Stroke Statistics Subcommittee
通讯作者：
American Heart Association Statistics Committee and Stroke Statistics Subcommittee
影响因子：
37.8
作者：
GROSSMAN, W;BRAUNWALD, E;GREEN, LH
通讯作者：
GREEN, LH