指南共识如何诊断保留射血分数的心力衰竭H

指南共识：如何诊断保留射血分数的心力衰竭：HFA-PEFF诊断流程：欧洲心脏病学会(ESC)心力衰竭协会(HFA)的共识

EuropeanHeartJournal()00,1-21，doi:10./eurheartj/ehz

Step1(P):Pre-testassessment：

Symptomsandsigns：Breathlessness/Orthopnoea/reducedexercisecapacityandfatigue

Electrocardiographicabnormalities:Sokolov-LyonIndex_3.5mV;abnormal

repolarisation，and/orLAenlargement

Laboratorytests:sodium,potassium,urea,andcreatinine(GFR);liverfunctiontests;HbAlc;thyroidstimulatinghormone;andfullbloodcount,ferritin,transferrinsaturation,andforanaemia

Natriureticpeptides：NT-proBNPpg/mLorBNP35pg/mLnegativepredictive

Values

Echocardiography：LVEF50%（defineapreservedEF）,LVD,LVEDV,LADenlargement

Exercisetests：abicycleortreadmillexercisetest,dobutaminestressechocardiography,cardiacmagneticresonance

Step2(E):Echocardiographicandnatriureticpeptideheartfailurewithpreservedejectionfractiondiagnosticscore

Echocardiographicmeasurementsoffunctionandmorphology

Septalandlateralmitralannularpeakearlydiastolicvelocity(e’)Majorcriterion:septale7cm/s;orlaterale10cm/ssubjectsaged75yearsMajorcriterion:septale5cm/s;orlaterale’7cm/ssubjectsaged≥75yearsAverageseptal-lateralE/e’ratioMajorcriterion:averageseptal-lateralE/e’ratio≥15Minorcriterion:averageseptal-lateralE/eratio9-14TricuspidregurgitationpeakvelocityorpulmonaryarterialsystolicpressureMajorcriterion:TRpeakvelocity2.8m/sMajorcriterion:Pulmonaryarterysystolicpressure35mmHgLeftventriculargloballongitudinalsystolicstrainMinorcriterion:GLS16%LeftatrialvolumeindexMajorcriterion:34mL/m2Majorcriterion:40mL/m2Minorcriterion:29-34mL/m2Minorcriterion:34-40mL/m2LeftventricularmassindexandrelativewallthicknessMajorcriterion:LVMI≥g/m2inmenor≥g/m2inwomenandRWT0.42Minorcriterion:LVMI≥g/m2inmenor≥95g/m2inwomenorRWT0.42orLVend-diastolicwallthickness≥12mmNatriureticpeptidesMajorcriterion:NT-proBNPpg/mL;orBNP80pg/mLMajorcriterion:NT-proBNPpg/mLorBNPpg/mLMinorcriterion:NT-proBNP-pg/mL;orBNP35-80pg/mLMinorcriterion:NT-proBNP-pg/mL;orBNP-pg/mL

CalculatingandinterpretingtheHFA-PEFFscore

Step3(Fl):Functionaltesting

Step4(F2):Finalaetiology

附：诊断流程图

附：HFA-PEFF常见病因

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