cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2021-2569cardiovascular-2569Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMНовые алгоритмы диагностики сердечной недостаточности с сохраненной фракцией выброса левого желудочка у пациентов с артериальной гипертензией и ожирениемNovel algorithms for diagnosing heart failure with preserved ejection fraction in patients with hypertension and obesityhttps://orcid.org/0000-0003-2913-9797ВасюкЮ. А.VasyukYu. A.

Юрий Александрович Васюк — доктор медицинских наук, профессор, заведующий кафедрой госпитальной терапии № 1

yvasyuk@yandex.ruhttps://orcid.org/0000-0001-6188-4610ШупенинаЕ. Ю.ShupeninaE. Yu.

Елена Юрьевна Шупенина — доцент кафедры клинической функциональной диагностики

eshupenina@mail.ruhttps://orcid.org/0000-0003-4870-0252НамазоваГ. А.NamazovaG. A.

Гюльнар Адиловна Намазова — ассистент кафедры госпитальной терапии № 1

m-medic@mail.ruhttps://orcid.org/0000-0003-0044-6056ДубровскаяТ. И.DubrovskayaT. I.

Татьяна Игоревна Дубровская — аспирант кафедры госпитальной терапии № 1

t.i.dubrovskaya@gmail.comМосковский государственный медико-стоматологический университетMoscow State University of Medicine and DentistryФГБОУ ВО Московский государственный медико-стоматологический университет им. А.И. Евдокимова Минздрава РоссииMoscow State University of Medicine and Dentistry20211802202120125692569Copyright © Васюк Ю.А., Шупенина Е.Ю., Намазова Г.А., Дубровская Т.И., 20212021Васюк Ю.А., Шупенина Е.Ю., Намазова Г.А., Дубровская Т.И.Vasyuk Y.A., Shupenina E.Y., Namazova G.A., Dubrovskaya T.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2569

Сердечная недостаточность с сохраненной фракцией выброса левого желудочка (СНсФВ) представляет собой сложный клинический синдром, ассоциированный с частыми госпитализациями, высоким уровнем смертности, отсутствием доказанной эффективной терапии. Данная форма сердечной недостаточности часто сопровождается коморбидными состояниями, затрудняющими диагностику основного заболевания. Разработанный в 2016г алгоритм не учитывает гетерогенность пациентов и особенности течения СНсФВ. В последнее время появляются новые алгоритмы диагностики (H2FPEF, HFA-PEFF) и биомаркеры, позволяющие выявлять СНсФВ на ранней стадии с учетом патогенетических механизмов развития, что может способствовать появлению новых эффективных методов лечения.

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome associated with frequent hospitalizations, high mortality rates, and an absence of proven effective therapy. This type of heart failure is often accompanied by comorbidity that complicate the diagnosis of the underlying disease. The algorithm developed in 2016 does not take into account the heterogeneity of patients and course of HFpEF. Recently, new diagnostic algorithms (H2FPEF, HFA-PEFF) and biomarkers have appeared that allow detecting HFpEF at an early stage, taking into account the pathogenesis, which may contribute to development of new effective treatment methods.

сердечная недостаточность с сохраненной фракцией выбросаэхокардиографиядиастолический стресс-тестга-лектин-3микроРНКheart failure with preserved ejection fractionechocardiographydiastolic stress testgalectin-3microRNAReferencesUl Haq M, Wong C, Hare D. Heart failure with preserved ejection fraction: an insight into its prevalence, predictors, and implications of early detection. Rev Cardiovasc Med. 2015;16(1):20-7.Ul Haq M, Wong C, Hare D. Heart failure with preserved ejection fraction: an insight into its prevalence, predictors, and implications of early detection. Rev Cardiovasc Med. 2015;16(1):20-7.van Riet E, Hoes A, Wagenaar K, et al. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail. 2016;18(3):242-52. doi:10.1002/ejhf.483.van Riet E, Hoes A, Wagenaar K, et al. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail. 2016;18(3):242-52. doi:10.1002/ejhf.483.Фомин И. В. Хроническая сердечная недостаточность в Российской Федерации: что сегодня мы знаем и что должны делать. Российский кардиологический журнал. 2016;8(136):7-13. doi:10.15829/1560-4071-2016-8-7-13.Fomin IV. Chronic heart failure in Russian Federation: what do we know and what to do. Russ J Cardiol. 2016;8(136):7-13. (In Russ.) doi:10.15829/1560-4071-2016-8-7-13.Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891-975. doi:10.1002/ejhf.592.Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891-975. doi:10.1002/ejhf.592.Мареев В. Ю., Фомин И. В., Агеев Ф. Т.и др. Клинические рекомендации ОССН-РКО-РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология. 2018;58(s6):8-164. doi:10.18087/cardio.2475.Mareev VYu, Fomin IV, Ageev FT, et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(s6):8-164. (In Russ.) doi:10.18087/cardio.2475.Venkatesh Y, Anjan M, Loftus M, et al. Prevalence, clinical phenotype and outcomes associated with normal B-type natriuretic peptide levels in heart failure with preserved ejection fraction. Am J Cardiol. 2012;110(6):870-6. doi:10.1016/j.amjcard.2012.05.014.Venkatesh Y, Anjan M, Loftus M, et al. Prevalence, clinical phenotype and outcomes associated with normal B-type natriuretic peptide levels in heart failure with preserved ejection fraction. Am J Cardiol. 2012;110(6):870-6. doi:10.1016/j.amjcard.2012.05.014.Roberts E, Ludman A, Dworzynski K, et al. The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. BMJ. 2015;350:h910. doi:10.1136/bmj.h910.Roberts E, Ludman A, Dworzynski K, et al. The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. BMJ. 2015;350:h910. doi:10.1136/bmj.h910.Nagueh S, Smiseth O, Appleton C, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29:277-314. doi:10.1016/j.echo.2016.01.011.Nagueh S, Smiseth O, Appleton C, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29:277-314. doi:10.1016/j.echo.2016.01.011.Caballero L, Kou S, Dulgheru R, et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging. 2015;16:1031-41. doi:10.1093/ehjci/jev083.Caballero L, Kou S, Dulgheru R, et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging. 2015;16:1031-41. doi:10.1093/ehjci/jev083.Reddy Y, Carter R, Obokata M, et al. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138(9):861-70. doi:10.1161/CIRCULATIONAHA.118.034646.Reddy Y, Carter R, Obokata M, et al. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138(9):861-70. doi:10.1161/CIRCULATIONAHA.118.034646.Sueta D, Yamamoto E, Nishihara T, et al. H2FPEF score as a prognostic value in HFpEF patients. Am J Hypertens. 2019;32(11):1082-90. doi:10.1093/ajh/hpz108.Sueta D, Yamamoto E, Nishihara T, et al. H2FPEF score as a prognostic value in HFpEF patients. Am J Hypertens. 2019;32(11):1082-90. doi:10.1093/ajh/hpz108.Мареев Ю. В., Гарганеева А. А., Тукиш О. В. и др. Сложности в диагностике сердечной недостаточности с сохраненной фракцией выброса в реальной клинической практике: диссонанс между клиникой, эхокардиографическими изменениями, величиной натрийуретических пептидов и шкалой H2FPEF. Кардиология. 2019;59(12S):37-45. doi:10.18087/cardio.n695.Mareev YuV, Garganeeva AA, Tukish OV, et al. Difficulties in diagnosis of heart failure with preserved ejection fraction in clinical practice: dissonance between echocardiography, NTproBNP and H2HFPEF score. Kardiologiia. 2019;59(12S):37-45. (In Russ.) doi:10.18087/cardio.n695.Pieske B, Tshope K, de Boer R, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic 24. algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40:3297-317. doi:10.1093/eurheartj/ehz641.Pieske B, Tshope K, de Boer R, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic 24. algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40:3297-317. doi:10.1093/eurheartj/ehz641.Gorter T, van Veldhuisen D, Bauersachs J, et al. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20:16-37. doi:10.1002/ejhf.102.Gorter T, van Veldhuisen D, Bauersachs J, et al. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20:16-37. doi:10.1002/ejhf.102.Voigt J, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16:1-11. doi:10.1016/j.echo.2014.11.003.Voigt J, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16:1-11. doi:10.1016/j.echo.2014.11.003.Shah A, Claggett B, Kitzman D, et al. Contemporary assessment of left ventricular diastolic function in older adults: the atherosclerosis risk in communities study. Circulation. 2017;135:426-39. doi:10.1161/CIRCULATIONAHA.116.024825.Shah A, Claggett B, Kitzman D, et al. Contemporary assessment of left ventricular diastolic function in older adults: the atherosclerosis risk in communities study. Circulation. 2017;135:426-39. doi:10.1161/CIRCULATIONAHA.116.024825.Chow S, Maisel A, Anand I, et al. Role of biomarkers for the prevention, assessment, and management of heart failure: a scientific statement from the American Heart Association. Circulation. 2017;135:e1054-91. doi:10.1161/CIR.0000000000000490.Chow S, Maisel A, Anand I, et al. Role of biomarkers for the prevention, assessment, and management of heart failure: a scientific statement from the American Heart Association. Circulation. 2017;135:e1054-91. doi:10.1161/CIR.0000000000000490.Meijers W, Hoekstra T, Jaarsma T, et al. Patients with heart failure with preserved ejection fraction and low levels of natriuretic peptides. Neth Heart J. 2016;24:287-95.Meijers W, Hoekstra T, Jaarsma T, et al. Patients with heart failure with preserved ejection fraction and low levels of natriuretic peptides. Neth Heart J. 2016;24:287-95.Obokata M, Kane G, Reddy Y, et al. Role of diastolic stress testing in the evaluation for heart failure with preserved ejection fraction: a simultaneous invasive-echocardiographic study. Circulation. 2017;135:825-38. doi:10.1161/CIRCULATIONAHA.116.024822.Obokata M, Kane G, Reddy Y, et al. Role of diastolic stress testing in the evaluation for heart failure with preserved ejection fraction: a simultaneous invasive-echocardiographic study. Circulation. 2017;135:825-38. doi:10.1161/CIRCULATIONAHA.116.024822.Lancellotti P, Pellikka P, Budts W, et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2016;17:1191-229. doi:10.1093/ehjci/jew190.Lancellotti P, Pellikka P, Budts W, et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2016;17:1191-229. doi:10.1093/ehjci/jew190.Obokata M, Borlaug B. The strengths and limitations of E/e’ in heart failure with preserved ejection fraction. Eur J Heart Fail. 2018;20:1312-4. doi:10.1002/ejhf.1250.Obokata M, Borlaug B. The strengths and limitations of E/e’ in heart failure with preserved ejection fraction. Eur J Heart Fail. 2018;20:1312-4. doi:10.1002/ejhf.1250.Овчинников А. Г., Агеев Ф. Т., Алехин М. Н. и др. Диастолическая трансторакальная стресс-эхокардиография с дозированной физической нагрузкой в диагностике сердечной недостаточности с сохраненной фракцией выброса: показания, методология, интерпретация результатов. УЗ и функц диагн. 2020;2:60-90. doi:10.24835/1607-0771-2020-2-60-90.Ovchinnikov AG, Ageev FT, Alekhin MN, et al. Diastolic transthoracic echocardiography with incremental work load in the evaluation of heart failure with preserved ejection fraction: indications, methodology, interpretation. US and Funct Diagn. 2020;2:60-90. (In Russ.) doi:10.24835/1607-0771-2020-2-60-90.van Riel A, Opotowsky A, Santos M, et al. Accuracy of echocardiography to estimate pulmonary artery pressures with exercise: a simultaneous invasive-noninvasive comparison. Circ Cardiovasc Imaging. 2017;10:e005711. doi:10.1161/CIRCIMAGING.116.005711.van Riel A, Opotowsky A, Santos M, et al. Accuracy of echocardiography to estimate pulmonary artery pressures with exercise: a simultaneous invasive-noninvasive comparison. Circ Cardiovasc Imaging. 2017;10:e005711. doi:10.1161/CIRCIMAGING.116.005711.Dorfs S, Zeh W, Hochholzer W, et al. Pulmonary capillary wedge pressure during exercise and long-term mortality in patients with suspected heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3103-12. doi:10.1093/eurheartj/ehu315.Dorfs S, Zeh W, Hochholzer W, et al. Pulmonary capillary wedge pressure during exercise and long-term mortality in patients with suspected heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3103-12. doi:10.1093/eurheartj/ehu315.Ferreira V, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol. 2018;72:3158-76. doi:10.1016/j.jacc.2018.09.072.25 Ferreira V, Schulz-Menger J, Holmvang G, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol. 2018;72:3158-76. doi:10.1016/j.jacc.2018.09.072.Song Y, Li F, Xu Y, et al. Prognostic value of sST2 in patients with heart failure with reduced, mid-range and preserved ejection fraction. Int J Cardiol. 2020;304:95-100. doi:10.1016/j.ijcard.2020.01.039.Song Y, Li F, Xu Y, et al. Prognostic value of sST2 in patients with heart failure with reduced, mid-range and preserved ejection fraction. Int J Cardiol. 2020;304:95-100. doi:10.1016/j.ijcard.2020.01.039.Cui Y, Qi X, Huang A, et al. Differential and Predictive Value of Galectin-3 and Soluble Suppression of Tumorigenicity-2 (sST2) in Heart Failure with Preserved Ejection Fraction. Med Sci Monit. 2018;24:5139-46. doi:10.12659/MSM.908840.Cui Y, Qi X, Huang A, et al. Differential and Predictive Value of Galectin-3 and Soluble Suppression of Tumorigenicity-2 (sST2) in Heart Failure with Preserved Ejection Fraction. Med Sci Monit. 2018;24:5139-46. doi:10.12659/MSM.908840.Edelmann F, Holzendorf V, Wachter R, et al. Galectin-3 in patients with heart failure with preserved ejection fraction: results from the Aldo-DHF trial. Eur J Heart Fail. 2015;17:214-23. doi:10.1002/ejhf.203.Edelmann F, Holzendorf V, Wachter R, et al. Galectin-3 in patients with heart failure with preserved ejection fraction: results from the Aldo-DHF trial. Eur J Heart Fail. 2015;17:214-23. doi:10.1002/ejhf.203.Hage C, Mihf^lsson E, Linde C, et al. Inflammatory biomarkers predict heart failure severity and prognosis in patients with heart failure with preserved ejection fraction. Circ Cardiovasc Genet. 2017;10:1-35. doi:10.1161/CIRCGENETICS.116.001633.Hage C, Mihf^lsson E, Linde C, et al. Inflammatory biomarkers predict heart failure severity and prognosis in patients with heart failure with preserved ejection fraction. Circ Cardiovasc Genet. 2017;10:1-35. doi:10.1161/CIRCGENETICS.116.001633.Watson CJ, Gupta S, O’Connell E, et al. MicroRNA signatures differentiate preserved from reduced ejection fraction heart failure. Eur J Heart Fail. 2015;17:405-15. doi:10.1002/ejhf.244.Watson CJ, Gupta S, O’Connell E, et al. MicroRNA signatures differentiate preserved from reduced ejection fraction heart failure. Eur J Heart Fail. 2015;17:405-15. doi:10.1002/ejhf.244.

The authors declare that there are no conflicts of interest present.