How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)
How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)
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DOI：
10.1002/ejhf.1741
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发表时间：
2020-03-01
影响因子：
18.2
通讯作者：
Filippatos, Gerasimos
中科院分区：
文献类型：
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作者：
Pieske, Burkert;Tschoepe, Carsten;Filippatos, Gerasimos
射血分数保留性慢性心力衰竭（HFpEF）的确诊仍是一个挑战。我们建议一个新的逐步诊断过程，“HFA-PEFF诊断算法”。第1步（P=试验前评估）通常在门诊环境中进行，包括心力衰竭症状和体征、典型临床人口统计学（肥胖、高血压、糖尿病、老年人、房颤）和诊断性实验室检查、心电图和超声心动图评估。在没有明显的非心源性呼吸困难的情况下，如果左心室（LV）射血分数正常，没有明显的心脏瓣膜疾病或心脏缺血，并且至少有一个典型的危险因素，则可以怀疑HFpEF。升高的利钠肽支持，但正常水平并不排除HFpEF的诊断。第二步（E：超声心动图和利钠肽评分）需要全面的超声心动图，通常由心脏病专家进行。测量包括二尖瓣环舒张早期速度（e '）、使用E/e '估计的LV充盈压、左心房容积指数、LV质量指数、LV相对壁厚度、三尖瓣反流速度、LV总体纵向收缩应变和血清利钠肽水平。根据这些指标定义了主要（2分）和次要（1分）标准。评分>= 5分意味着明确的HFpEF;
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes ofbreathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e '), LV filling pressure estimated using E/e ', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score >= 5 points implies definite HFpEF;