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首页> 外文期刊>Circulation journal >Hemodynamic classifications of acute heart failure and their clinical application - An update
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Hemodynamic classifications of acute heart failure and their clinical application - An update

机译：急性心力衰竭的血流动力学分类及其临床应用

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Acute heart failure (AHF) is classically defined by signs and symptoms related to elevated ventricular filling pressures. Regardless of precipitant, underlying etiology or ejection fraction, the vast majority of hospital admissions are the result of worsening chronic HF. For the acutely decompensated patient, 4 hemodynamic profiles, stratified by degree of congestion ("dry" or "wet") and adequacy of perfusion ("warm" or "cold") predict prognosis and guide therapy. Relief of congestion is the primary goal of AHF management. Loop diuretics remain the mainstay of AHF treatment, but new modalities such as veno-venous ultrafiltration are promising. For patients with evidence of hypoperfusion, vasoactive agents may be needed to facilitate diuresis. The decision to use vasodilators or inotropes is complex and the need for invasive hemodynamic monitoring is often determined by the individual patient's characteristics. Routine use of inotropes should be discouraged; however when used, the short-term hemodynamic benefits conferred by these agents must be balanced against their tendency to increase adverse events. Although these strategies are effective in alleviating symptoms in most patients, management dilemmas arise from cardiorenal interactions and limitations in effective novel therapies. Epidemiological studies continue to emphasize that AHF portends a poor prognosis. Further studies are needed to improve our understanding and outcomes in this growing patient population.
机译：急性心力衰竭（AHF）的经典定义是与心室充盈压升高有关的体征和症状。不管沉淀物，潜在病因或射血分数如何，绝大多数的住院治疗都是由于慢性心力衰竭恶化所致。对于严重失代偿的患者，按充血程度（“干”或“湿”）和灌注充分（“温暖”或“寒冷”）分层的4种血液动力学特征可预测预后并指导治疗。缓解交通拥堵是AHF管理的主要目标。 di利尿剂仍然是AHF治疗的主要手段，但是诸如静脉-静脉超滤之类的新方法很有希望。对于有灌注不足迹象的患者，可能需要血管活性药物来促进利尿。使用血管扩张药或正性肌力药的决定很复杂，侵入性血流动力学监测的需求通常取决于患者的个人特征。应避免常规使用正性肌力药。但是，在使用时，必须权衡这些药物所带来的短期血液动力学益处和其增加不良事件的趋势。尽管这些策略可有效减轻大多数患者的症状，但管理上的两难选择来自心肾相互作用和有效新型疗法的局限性。流行病学研究继续强调，AHF预后不良。需要进一步的研究来增进我们对这个不断增长的患者群体的了解和结果。

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