高血压急性心力衰竭:定义、流行病学、病理生理学和预后的关键观点——与罗马尼亚心脏病学会联合会议的叙述性回顾(第二部分)。

IF 4.2 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Oliviana Geavlete, Sean P Collins, Alexandre Mebazaa, Linda Ye, Alberto Palazzuoli, Laura Antohi, Jan Biegus, Matteo Pagnesi, Petar Seferovic, Razvan I Radu, Avishay Grupper, Oscar Miro, Beth Davison, Magdy Abdelhamid, Marija Polovina, Mitja Lainshack, Marianna Adamo, Gad Cotter, Gianluigi Savarese, Mehmet Birhan Yilmaz, Maurizio Volterani, Giuseppe M C Rosano, Javed Butler, Andrew P Ambrosy, Ovidiu Chioncel
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引用次数: 0

摘要

高血压急性心力衰竭(HT-AHF)历来被认为是一种独特的AHF临床表型,其特征是在收缩压(SBP)升高的背景下出现急性肺充血,通常为bb0 - 140 mmHg。然而,新出现的证据已经开始挑战这一类别的诊断准确性、临床实用性和相关性。对HT-AHF的主要批评是其与其他AHF临床特征有相当大的重叠,包括急性失代偿性心力衰竭(ADHF)和急性肺水肿(APO)。临床特征如呼吸困难和肺充血并不是HT-AHF独有的。此外,一些HT-AHF患者同时满足ADHF表型的诊断标准,包括HF病史或容量过载迹象,导致诊断不明确。与其他AHF表型相比,HT-AHF与非常低的住院死亡率(0-2%)相关。值得注意的是,没有强有力的证据将高收缩压与不良的短期或长期结果联系起来,也没有随机临床试验验证HT-AHF的不同管理策略。血管扩张剂通常与HT-AHF的治疗相关,在所有试验中显示出有限的益处,导致指南建议的降级。相对良好的短期预后和缺乏标准化的循证治疗方法削弱了将HT-AHF单独分类为AHF的理由。考虑到临床表现的异质性,与其他AHF表型的重叠,以及缺乏预后区分或靶向治疗,“表现时伴有高收缩压的AHF”这一术语提供了一个更灵活和有临床意义的描述,鼓励采用更细致的治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hypertensive acute heart failure: a critical perspective on definition, epidemiology, pathophysiology, and prognosis-a narrative review: a joint session with the Romanian Society of Cardiology (part II).

Hypertensive acute heart failure (HT-AHF) has historically been recognized as a distinct clinical phenotype of AHF, characterized by acute pulmonary congestion in the context of elevated systolic blood pressure (SBP), typically > 140 mmHg. However, emerging evidence has begun to challenge the diagnostic accuracy, clinical utility, and relevance of this category. A main criticism of HT-AHF is its considerable overlap with other AHF clinical profiles, including acute decompensated heart failure (ADHF) and acute pulmonary oedema (APO). Clinical features such as dyspnea and pulmonary congestion are not unique to HT-AHF. Additionally, some HT-AHF patients concurrently fulfill diagnostic criteria for the ADHF phenotype, including a history of HF or signs of volume overload, leading to ambiguity in diagnosis. HT-AHF is associated with very low in-hospital mortality (0-2%) compared to other AHF phenotypes. Notably, there is no robust evidence linking high SBP to poor short- or long-term outcomes, nor are there randomized clinical trials validating distinct management strategies for HT-AHF. Often associated with the management of HT-AHF, vasodilators have shown limited benefit across trials, contributing to a downgrade in guideline recommendations. The relatively favorable short-term prognosis and the lack of a standardized, evidence-based treatment approach weaken the rationale for classifying HT-AHF as a standalone AHF category. Given the heterogeneity of clinical presentations, overlap with other AHF phenotypes, and lack of prognostic distinction or targeted therapy, the term "AHF with high SBP at presentation" offers a more flexible and clinically meaningful descriptor, encouraging a more nuanced approach to treatment.

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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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