Update of treatment of heart failure with reduction of left ventricular ejection fraction.
Update of treatment of heart failure with reduction of left ventricular ejection fraction.
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DOI：
10.5114/amsad.2016.63002
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Aronow WS
中科院分区：
文献类型：
--
作者：
Aronow WS
左心射血分数(HFrEF)降低的心力衰竭(HF)的潜在和诱因应被识别并在可能的情况下进行治疗。高血压应使用利尿剂、血管紧张素转换酶抑制剂和β阻滞剂治疗。利尿剂是治疗HFrEF和容量超负荷患者的一线药物。血管紧张素转换酶抑制剂和β受体阻滞剂(卡维地洛、琥珀酸美托洛尔缓释片或比索洛尔)应用于治疗高危心脏衰竭。如果因咳嗽或血管神经性水肿而对血管紧张素转换酶抑制剂不耐受，可使用血管紧张素II受体阻滞剂(ARB)(坎地沙坦或valsartan)。对于慢性症状性HFrEF II级或III级患者，可使用萨舒比利/valsartan来替代ACE抑制剂或ARB，以进一步降低发病率和死亡率。在选定的II-IV级心衰患者中添加一种醛固酮拮抗剂(螺内酯或依普利酮)，这些患者可以仔细监测肾功能和钾浓度。(男性血肌酐应为≤2.5mgdl，女性应为≤2.0mgdl。血钾应低于5.0mEq/L)。对于自称非裔美国人、心力衰竭II-IV级患者使用利尿剂、血管紧张素转换酶抑制剂和β阻滞剂治疗的患者，加用硝酸异山梨酯和肼。伊夫拉定可用于部分HFrEF患者。
Underlying and precipitating causes of heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) should be identified and treated when possible. Hypertension should be treated with diuretics, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers. Diuretics are the first-line drugs in the treatment of patients with HFrEF and volume overload. Angiotensin-converting enzyme inhibitors and β-blockers (carvedilol, sustained-release metoprolol succinate, or bisoprolol) should be used in treatment of HFrEF. Use an angiotensin II receptor blocker (ARB) (candesartan or valsartan) if intolerant to ACE inhibitors because of cough or angioneurotic edema. Sacubitril/valsartan may be used instead of an ACE inhibitor or ARB in patients with chronic symptomatic HFrEF class II or III to further reduce morbidity and mortality. Add an aldosterone antagonist (spironolactone or eplerenone) in selected patients with class II–IV HF who can be carefully monitored for renal function and potassium concentration. (Serum creatinine should be ≤ 2.5 mg/dl in men and ≤ 2.0 mg/dl in women. Serum potassium should be < 5.0 mEq/l). Add isosorbide dinitrate plus hydralazine in patients self-described as African Americans with class II–IV HF being treated with diuretics, ACE inhibitors, and β-blockers. Ivabradine can be used in selected patients with HFrEF.