Сердечная недостаточность с сохранённой фракцией выброса — диагностика и лечение: краткий обзор литературы

Лаксоно С., Прамесвари П.С. Сердечная недостаточность с сохранённой фракцией выброса — диагностика и лечение: краткий обзор литературы // CardioСоматика. 2024. Т. 15, № 1. С. 71–79.
DOI: https://doi.org/10.17816/CS623815

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Laksono S, Prameswari PS. Heart failure with preserved ejection fraction: A short review of diagnosis and management. CardioSomatics. 2024;15(1):71–79. DOI: https://doi.org/10.17816/CS623815

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Аннотация

Около 64 млн человек в мире страдают сердечной недостаточностью (СН). СН, при которой фракция выброса левого желудочка (ФВ ЛЖ) составляет ≥50%, классифицируют как СН с сохранённой фракцией выброса (СНсФВ). По оценкам, около 50% всех случаев СН приходится на СНсФВ. Нашей целью было описать современные данные по диагностике и лечению СНсФВ. Мы производили поиск литературы, посвящённой диагностике и лечению СНсФВ, в базах данных Google Scholar и PubMed Central (PMC). Существует несколько критериев для диагностики СНсФВ, включая ФВ >50%, признаки диастолической дисфункции, повышенный уровень мозгового натрийуретического пептида. Высокий (≥15) или средний (9–14) показатель отношения скорости митрального притока E к скорости митральной кольцевой релаксации eʹ (E/eʹ) указывает на вероятность развития СНсФВ. Терапия ингибиторами натрий-глюкозного котранспортёра 2-го типа (иНГЛТ-2) уменьшает соотношение E/eʹ, что свидетельствует об улучшении диастолической функции ЛЖ, как отмечалось в нескольких исследованиях. Продолжительность лечения для достижения этого эффекта составляет от 3 мес до 1 года. иНГЛТ-2 оказывают положительное влияние на эхокардиографические параметры пациентов с СНсФВ. В исследованиях, включённых в обзор, в качестве первичной конечной точки оценки эффективности терапии в основном использовали показатель E/eʹ.

Ключевые слова: сердечная недостаточность с сохранённой фракцией выброса, ингибиторы натрий-глюкозного котранспортёра 2-го типа, диастолическая функция левого желудочка, отношение скорости митрального притока к скорости митральной кольцевой релаксации

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Around 64 million persons in the world have heart failure (HF). HF patients with left ventricle ejection fraction (LVEF) of ≥50% are classified as having HF with preserved ejection fraction (HFpEF). It is estimated that about fifty percent of all HF is HFpEF. Our aim was to provide evidence of contemporary data regarding diagnosis and management of HFpEF. We conducted literature search through online search such as Google Scholar and PubMed Central (PMC), focusing on diagnosis and management of HFpEF. Several criteria exist for the diagnosis of HFpEF, including EF >50%, evidence of diastolic dysfunction, elevated brain natriuretic peptide. High (≥15) or intermediate (9–14) E/eʹ index indicates the likelihood of HFpEF. SGLT2I decrease E/eʹ, indicating improvement of LV diastolic function as mentioned in several studies. Treatment duration to achieve this effect spans from 3 months to 1 year. SGLT2I have positive effect on echocardiographic parameter HFpEF patients. In the researches included in the review, E/eʹ was mainly used as primary end point.

Keywords: HFpEF, SGLT2 inhibitor, left ventricular diastolic function, ratio of the velocity of mitral inflow to the velocity of mitral annular relaxation

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Список литературы

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2. McDonagh T.A., Metra M., Adamo M., et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure // Eur Heart J. 2021. Vol. 42, N 36. P. 3599–3726. doi: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021. Oct 14.
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4. Egashira K., Sueta D., Komorita T., et al. HFA-PEFF scores: prognostic value in heart failure with preserved left ventricular ejection fraction // Korean J Intern Med. 2022. Vol. 37, N 1.
P. 96–108. doi: 10.3904/kjim.2021.272
5. PERKI. Pedoman Tatalaksana Gagal Jantung. Perhimpunan Dokter Spesialis Kardiovaskular. Indonesia, 2020. P. 848–853.
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13. Santos-Gallego C.G., Requena-Ibanez J.A., San Antonio R., et al. Empagliflozin Ameliorates Diastolic Dysfunction and Left Ventricular Fibrosis / Stiffness in Nondiabetic Heart Failure: A Multimodality Study // JACC Cardiovasc Imaging. 2021. Vol. 14, N 2. P. 393–407. doi: 10.1016/j.jcmg.2020.07.042
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P. 73. doi: 10.1186/s12933-018-0717-9
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1. Redfield MM, Borlaug BA. Heart Failure With Preserved Ejection Fraction: A Review. JAMA. 2023;329(10):827–838. doi: 10.1001/jama.2023.2020
2. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–3726.
doi: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021. Oct 14
3. Mumpuni H, Adhi Kusumastuti D, Purnasidha Bagaswoto H, Yuli Setianto B. Epidemiology, Aetiology and Risk Profile of Heart Failure in a Tertiary Referral Hospital: a Report from the Sardjito Heart Failure Registry. Acta Cardiologia Indonesiana. 2020;7(1):7–12.
4. Egashira K, Sueta D, Komorita T, et al. HFA-PEFF scores: prognostic value in heart failure with preserved left ventricular ejection fraction. Korean J Intern Med. 2022;37(1):96–108.
doi: 10.3904/kjim.2021.272
5. PERKI. Pedoman Tatalaksana Gagal Jantung. Perhimpunan Dokter Spesialis Kardiovaskular. Indonesia; 2020. P. 848–853.
6. Pieske B, Tschöpe C, de Boer RA, et al. 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). Eur Heart J. 2019;40(40):3297–3317. doi: 10.1093/eurheartj/ehz641. Erratum in: Eur Heart J. 2021;42(13):1274.
7. Laksono S, Hosea GT, Nurusshofa Z. Diabetic Cardiomyopathy: Pathophysiology and Novel Therapies. Brown Hospital Medicine. 2022;1(3). Available from: https://bhm.scholasticahq.com/article/37850-diabetic-cardiomyopathy-pathophysiology-and-novel-therap.... doi: 10.56305/001c.37850
8. Sotomi Y, Iwakura K, Hikoso S, et al. Prognostic significance of the HFA-PEFF score in patients with heart failure with preserved ejection fraction. ESC Heart Fail.
2021;8(3):2154–2164. doi: 10.1002/ehf2.13302
9. Putra MGD, Laksono S. Sodium Glucose Co-Transporter-2 (SGLT 2) Inhibitor as A Therapy For Heart Failure With Low Ejection Fraction (HFrEF). FITOFARMAKA: Jurnal Ilmiah Farmasi. 2022;12(2):148–55.
10. Laksono S. Heart Failure Clinic: A Practical Guide for Health Practitioners in Hospitals. Jurnal Kesehatan Pasak Bumi Kalimantan. 2022;5(1):32–36.
11. Besmaya BM, Laksono S. Mekanisme Penghambat Sodium-Glukosa Transport Protein-2 (SGLT2-i) pada Penyakit Kardiovaskular: Sebuah Tinjauan. MPI (Media Pharmaceutica Indonesiana). 2023;5(1):71–85. (In Indonesian). doi: 10.24123/mpi.v5i1.5266
12. Laksono S, Syukran. Management of Heart Failure in the Hospital: A Clinical Approach. Ahmad Dahlan Medical Journal. 2023;4(2);117–132.
13. Santos-Gallego CG, Requena-Ibanez JA, San Antonio R, et al. Empagliflozin Ameliorates Diastolic Dysfunction and Left Ventricular Fibrosis/Stiffness in Nondiabetic Heart Failure: A Multimodality Study. JACC Cardiovasc Imaging. 2021;14(2):393–407. doi: 10.1016/j.jcmg.2020.07.042
14. Redfield MM. Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2016;375(19):1868–1877. doi: 10.1056/NEJMcp1511175
15. Akasaka H, Sugimoto K, Shintani A, et al. Effects of ipragliflozin on left ventricular diastolic function in patients with type 2 diabetes and heart failure with preserved ejection fraction: The EXCEED randomized controlled multicenter study. Geriatr Gerontol Int. 2022;22(4):298–304. doi: 10.1111/ggi.14363
16. Sakai T, Miura S. Effects of Sodium-Glucose Cotransporter 2 Inhibitor on Vascular Endothelial and Diastolic Function in Heart Failure With Preserved Ejection Fraction — Novel Prospective Cohort Study. Circ Rep. 2019;1(7):286–295. doi: 10.1253/circrep.CR-19-0018
17. Soga F, Tanaka H, Tatsumi K, et al. Impact of dapagliflozin on left ventricular diastolic function of patients with type 2 diabetic mellitus with chronic heart failure. Cardiovasc Diabetol. 2018;17(1):132. doi: 10.1186/s12933-018-0775-z
18. Matsutani D, Sakamoto M, Kayama Y, et al. Effect of canagliflozin on left ventricular diastolic function in patients with type 2 diabetes. Cardiovasc Diabetol. 2018;17(1):73.
doi: 10.1186/s12933-018-0717-9
19. Santos-Gallego CG, Vargas-Delgado AP, Requena-Ibanez JA, et al. Randomized Trial of Empagliflozin in Nondiabetic Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol. 2021;77(3):243–255. doi: 10.1016/j.jacc.2020.11.008
20. Cappetta D, De Angelis A, Ciuffreda LP, et al. Amelioration of diastolic dysfunction by dapagliflozin in a non-diabetic model involves coronary endothelium. Pharmacol Res.
2020;(157):104781. doi: 10.1016/j.phrs.2020.104781

Авторы

С. Лаксоно*^1,2, П.С. Прамесвари¹
¹Больница Румах Сакит Силоам Цинере, Западная Ява, Индонезия;
²Университет Мухаммадии им. проф. Хамки, Тангеранг, Индонезия
*sidhilaksono@uhamka.ac.id

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Sidhi Laksono*^1,2, Prita Saskya Prameswari¹

¹Diagram Heart Hospital Siloam Cinere, West Java, Indonesia;
²Universitas Muhammadiyah Prof Dr Hamka, Tangerang, Indonesia
*sidhilaksono@uhamka.ac.id

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