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Heart failure with reduced ejection fraction

Last reviewed: 17 Aug 2025
Last updated: 03 Apr 2025

Summary

Definition

Анамнез и осмотр

Ключевые диагностические факторы

  • dyspnea
  • neck vein distension
  • S3 gallop
  • cardiomegaly
  • hepatojugular reflux
  • rales
  • orthopnea and paroxysmal nocturnal dyspnea
  • nocturia
Полная информация

Другие диагностические факторы

  • tachycardia (heart rate >120 beats per minute)
  • chest discomfort
  • hepatomegaly
  • ankle edema
  • night cough
  • signs of pleural effusion
  • fatigue, muscle weakness, or tiredness
  • palpitations, presyncope, or syncope
  • lethargy/confusion
Полная информация

Факторы риска

  • coronary artery disease (CAD)
  • myocardial infarction (MI)
  • hypertension
  • diabetes mellitus
  • dyslipidemia
  • older age
  • male sex
  • obesity
  • exposure to cardiotoxic agents
  • left ventricular dysfunction
  • left ventricular hypertrophy
  • renal insufficiency
  • valvular heart disease
  • sleep apnea
  • elevated homocysteine
  • cocaine use
  • family history of HF
  • atrial fibrillation
  • thyroid disorders
  • anemia
  • elevated tumor necrosis factor-alfa (TNF-alfa) and interleukin-6 (IL-6)
  • elevated C-reactive protein (CRP)
  • decreased insulin-like growth factor-1 (IGF-1)
  • elevated natriuretic peptides
  • dilation of the left ventricle
  • increased left ventricular mass
  • abnormal left ventricular diastolic filling
  • metabolic syndrome or cardiovascular-kidney-metabolic (CKM) syndrome
  • low socioeconomic status
  • tobacco consumption
  • alcohol misuse
  • excess sodium intake
  • tachycardia
  • depression/stress
  • microalbuminuria
  • aspirin use
  • micronutrient deficiency
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • transthoracic echocardiogram
  • ECG
  • CXR
  • B-type natriuretic peptide (BNP)/N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels
  • CBC
  • urinalysis
  • serum electrolytes (including calcium and magnesium)
  • serum creatinine, BUN
  • blood glucose
  • LFT
  • thyroid function tests (especially thyroid-stimulating hormone [TSH])
  • blood lipids
Полная информация

Исследования, проведение которых нужно рассмотреть

  • serum ferritin
  • transferrin saturation
  • noninvasive stress imaging (cardiovascular MRI, stress echocardiogram, SPECT, PET)
  • standard exercise stress testing (bicycle or treadmill)
  • coronary angiogram
  • cardiac CT angiography
  • cardiopulmonary exercise testing with VO₂ max
  • 6-minute walking test exercise
  • right heart catheterization
  • endomyocardial biopsy
  • serum HIV enzyme-linked immunosorbent assay
  • cardiac MRI
  • other biomarkers
  • multi-slice computed tomography (MSCT)
Полная информация

Алгоритм лечения

ПРОДОЛЖЕНИЕ

symptomatic HF: LVEF ≤40%

symptomatic HF: LVEF 41% to 49%

advanced HF

Составители

Авторы

Syed Wamique Yusuf, FACC, FRCPI
Syed Wamique Yusuf

Professor of Medicine

Department of Cardiology

University of Texas MD Anderson Cancer Center

Houston

TX

Раскрытие информации

SWY declares that he has no competing interests.

Выражение благодарностей

Dr Syed Wamique Yusuf would like to gratefully acknowledge Dr Andrew R.J. Mitchell, Dr Grigorios Giamouzis, Dr Sonjoy Raja Laskar, and Dr Javed Butler, the previous contributors to this topic.

Раскрытие информации

ARJM, GG, SRL, and JB declare that they have no competing interests.

Рецензенты

David Leaf, MD, MPH

Professor of Medicine

VA Greater Los Angeles Healthcare System

UCLA School of Medicine

Los Angeles

CA

Раскрытие информации

DL declares that he has no competing interests.

Brian Griffin, MD

Director

Cardiovascular Training Program

Cleveland Clinic

Cleveland

OH

Раскрытие информации

BG declares that he has no competing interests.

Abdallah Al-Mohammad, MD, FRCP(Edin.), FRCP(Lond.)

Consultant Cardiologist and Heart Failure Lead

Sheffield Teaching Hospitals NHS Foundation Trust (Northern General Hospital)

Sheffield

UK

Declarações

AAM has accepted hospitality by NOVARTIS in 2008 to attend the American College of Cardiology meeting in Chicago, and had received honoraria for delivering educational talks before 2008. AAM is the co-author of the NICE chronic heart failure partial update of the guideline in 2010, and of several related articles.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J Card Fail. 2021 Apr 1;27(4):387-413.Texto completo  Resumo

Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure. Eur J Heart Fail. 2020 Aug;22(8):1342-56.Texto completo  Resumo

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-1032.Texto completo  Resumo

McDonagh TA, Metra M, Adamo M, et al; ESC Scientific Document Group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.Texto completo  Resumo

McKee PA, Castelli WP, McNamara PM, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441-6. Resumo

National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management. Sep 2018 [internet publication].Texto completo

McDonagh TA, Metra M, Adamo M, et al. 2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-39.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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