射血分数降低型心力衰竭与慢性肾脏病:重点关注疗法和干预措施。

IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Hesham Salah Eldin Taha, Mohamed Momtaz, Ahmed Adel Elamragy, Omar Younis, Mera Alfred Sabet Fahim
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引用次数: 0

摘要

在射血分数降低型心力衰竭(HFrEF)患者中,如果同时患有慢性肾脏疾病(CKD),则心血管预后较差,心力衰竭(HF)状况更严重,死亡率更高。由于担心肾功能恶化和不良事件发生率升高,医生可能不愿意开始使用救命的抗心衰药物。此外,由于晚期慢性肾功能衰竭一直是大多数主要心房颤动试验的排除标准,因此国际指南并未就如何管理这部分患者给出明确建议。尽管如此,在这篇综述中,我们将重点介绍最近的几项临床试验和对主要试验的事后分析,这些试验和分析表明了不同疗法对伴有 CKD 的 HFrEF 患者的安全性和有效性,此外,我们还将介绍几项小规模的队列研究,这些研究对终末期肾病(ESKD)的指导性医疗疗法进行了测试。关于该亚组患者的干预措施,我们将提供有关植入式心律转复除颤器、心脏再同步化疗法、冠状动脉血运重建以及二尖瓣经导管边缘对边缘修复和植入式肺动脉压力传感器的最新数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Heart failure with reduced ejection fraction and chronic kidney disease: a focus on therapies and interventions.

In heart failure with reduced ejection fraction (HFrEF), the presence of concomitant chronic kidney disease (CKD) predicts poorer cardiovascular outcomes, more aggravated heart failure (HF) status, and higher mortality. Physicians might be reluctant to initiate life-saving anti-HF medications out of fear of worsening renal function and a higher incidence of adverse events. Moreover, international guidelines do not give clear recommendations on managing this subgroup of patients as well as advanced CKD was always an exclusion criterion in most major HF trials. Nevertheless, in this review, we will highlight several recent clinical trials and post-hoc analyses of major trials that showed the safety and efficacy of the different therapies in HFrEF patients with CKD, besides several small-scale cohorts that tested guideline-directed medical therapies in End Stage Kidney Disease (ESKD). Regarding interventions in this subgroup of patients, we will provide up-to-date data on implantable cardioverter defibrillators, cardiac resynchronization therapy, and coronary revascularization, in addition to mitral valve transcatheter edge-to-edge repair and implantable pulmonary artery pressure sensors.

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来源期刊
Heart Failure Reviews
Heart Failure Reviews 医学-心血管系统
CiteScore
10.40
自引率
2.20%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.
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