|
Cardiologia Ambulatoriale - Outpatient Cardiology https://www.cardiologiaambulatoriale.eu/heart-failure-phenotypes-hfref-hfmref-hfpef-diagnosis-prognosis-and-differential-therapies/ Export date: Thu Sep 12 1:50:03 2024 / +0000 GMT |
Heart failure phenotypes: HFrEF, HFmrEF, HfpEF Diagnosis, prognosis and differential therapiesI fenotipi dello scompenso cardiaco: HFrEF, HFmrEF, HfpEF Diagnosi, prognosi e terapie differenziali Alessandro Boccanelli UniCamillus-International Medical University, Rome Abstract La classificazione dello scompenso cardiaco (SC) secondo i livelli di frazione di eiezione (FE) non è sufficiente per un corretto inquadramento clinico e per le scelte terapeutiche. Nonostante questo, la suddivisione nelle diverse fasce di FE (FE ridotta, moderatamente ridotta, preservata – HFrEF, HFmrEF, HfpEF) è utile per un iniziale inquadramento fisiopatologico e in quanto le scelte terapeutiche dettate dalle Linee Guida sono nate dai trial basati su questo tipo di classificazione. Un migliore orientamento alle scelte terapeutiche si ottiene associando al valore di FE la stadiazione clinica e la sua evoluzione, nonché la considerazione della eziologia e fisiopatologia del caso individuale e delle comorbosità. È opportuno associare alla suddivisione in tre categorie quella della FE modificata dalla terapia o dalla storia naturale (FE migliorata o peggiorata), per considerare la necessità di adattare le cure alle condizioni variate nel tempo. Parole chiave: Scompenso cardiaco; Fenotipi; Frazione di eiezione; Terapia personalizzata. Abstract The classification of heart failure (HF) according to the levels of ejection fraction (EF) is not sufficient for a correct clinical picture and for therapeutic choices. Despite this, the subdivision into the different EF bands (reduced, moderately reduced, preserved – HFrEF, HFmrEF, HfpEF) is useful for an initial physiopathological classification and because the therapeutic choices dictated by the Guidelines were born from trials based on this type classification. A better orientation to therapeutic choices is obtained by associating the EF value with the clinical staging and its evolution, as well as the consideration of the etiology and pathophysiology of the individual case and comorbidities. It is appropriate to associate the subdivision into three categories with that of EF modified by therapy or by natural history (EF improved or worsened), to consider the need to adapt treatments to conditions that vary over time. As far as HFrEF is concerned, the European, Canadian and American Guidelines, while unanimously recognizing the four categories of essential drugs (ARNI, BB, MRA, SGLT2i) differ slightly on the times and methods of titration to the doses indicated as effective. The most complex category, which is increasing epidemiologically, is that with preserved EF, in which very heterogeneous clinical situations come together, to be carefully identified in order to personalize treatment. The SGLT2i category of drugs has proven to be effective in all categories of EF, so that today the diagnosis of HF is sufficient, regardless of the value of EF, to have to use this therapy. Key words: Heart failure; Phenotypes; Ejection fraction; Tailored therapy |
|
Post date: 2023-09-01 11:48:02 Post date GMT: 1970-01-01 00:00:00 Post modified date: 2024-03-11 14:00:17 Post modified date GMT: 2024-03-11 14:00:17 |
|
Export date: Thu Sep 12 1:50:03 2024 / +0000 GMT This page was exported from Cardiologia Ambulatoriale - Outpatient Cardiology [ https://www.cardiologiaambulatoriale.eu ] Export of Post and Page has been powered by [ Universal Post Manager ] plugin from www.ProfProjects.com |
