Öz
Kalp yetmezliği tanısı olan ve sıklıkla yaşlı kadın hasta popülasyonunda korunmuş ejeksiyon fraksiyonlu kalp yetmezliği (HFpEF) görülmektedir. Bu hastalar efor ile gelen ciddi semptomlar, sık hastaneye yatış, kötü hayat kalitesi ve daha yüksek mortaliteye sahiptir. HFpEF prevalansı giderek artarken prognoz kötüdür. Tetikleyen inflamatuar süreç tedavi edilmedikçe semptom ve bulgular hızla ilerleyecektir. Bu hasta grubunda özellikle romatolojik hastalık tanısı olanlarda altta yatan hastalığın alevlenmesine bağlı sitokin fırtınası sonucu HFpEF gelişmiş olabileceği akla gelmelidir. Romatolojik hastalığın ilk bulgusu HFpEF de olabilir. Bu nedenle kalp yetmezliği semptomları ile başvuran hastaların değerlendirilmesinde EF dışında kriterlerin de önemli olacağı bilinmelidir. Tedavide öncelikle tetikleyen faktörlerin düzeltilmesi, kan basıncı kontrolü, yaşam tarzı değişikliğini içermektedir.
Anahtar Kelimeler
İnflamasyon, sitokin fırtınası, korunmuş ejeksiyon fraksiyonlu kalp yetmezliği, mortalite, tedavi.
Kaynakça
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37 ( 27): 2129-200.
- Oren O, Goldberg S. Heart failure with preserved ejection fraction: diagnosis and management. Am J Med 2017; 130 ( 5): 510-6.
- Borlaug BA, Lam CSP, Roger VL, Rodeheffer RJ,Redfield MM. Contractility and ventricular systolic stiffening in hypertensive heart disease. J Am Coll Cardiol 2009; 54 (5): 410-8.
- Melenovsky V, Borlaug BA, Rosen B. et al. Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community. The role of atrial remodeling/dysfunction. J Am Coll Cardiol 2007; 49 (2): 198-207.
- Gorter TM, Hoendermis ES, van Veldhuisen DJ et al. Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur J Heart Fail 2016;18 (12): 1472-87.
- Lam CSP, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction. A community-based study. J Am Coll Cardiol 2009; 53 (13): 1119-26.
- Van Linthout S, Tschöpe C. Inflammation – Cause or consequence of heart failure or both? Curr Heart Fail Rep 2017; 14 (4): 251-65.
- Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 2013; 62 (4): 263-71.
- Torre-Amione G, Kapadia S, Benedict C, Oral H, Young JB, Mann DL. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: A report from the studies of left ventricular dysfunction (SOLVD). J Am Coll Cardiol 1996; 27 (5): 1201-6.
- Bozkurt D, Kılıç S. Kardiyo-immünoloji. In: Bozkurt D (ed). İç Hastalıklarında İmmün Sistem İlişkili Aciller. 1.Baskı. Ankara: Palme Yayınevi; 2019: 99-113.
- Thomas JT, Kelly RF, Thomas SJ. et al. Utility of history, physical examination, electrocardiogram, and chest radiograph for differentiating normal from decreased systolic function in patients with heart failure. Am J Med 2002; 112 (6): 437-45.
- Yusuf S, Pfeffer MA, Swedberg K. et al., Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: The CHARM-preserved trial. Lancet 2003; 362 (9386): 777-81.
- Forman D, Gaziano JM. Irbesartan in patients with heart failure and preserved ejection fraction. Curr Cardiovasc Risk Rep 2009; 3 (5): 311-2.
- Cleland JGF, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 2006; 27 (19): 2338-45.
- Pitt B, Pfeffer MA, Assmann SF,et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 2014; 370 (15): 1383-92.
- Flather MD, Shibata MC, Coats AJ, et al., FASTTRACK Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005; 26 (3): 215-25.
- Lam CSP, Voors AA, De Boer RA, Solomon SD, Van Veldhuisen DJ, Heart failure with preserved ejection fraction: From mechanisms to therapies. Eur Heart J 2018; 39 (30): 2780-92.
- Zandman-Goddard G, Blank M, Shoenfeld Y. Intravenous immunoglobulins in systemic lupus erythematosus: From the bench to the bedside. Lupus 2009; 18 (10): 884-88.
- Adamson PB, Abraham WT, Bourge RC, et al. Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Hear Fail 2014; 7 (6): 935-44.
Öz
Older patients who have heart failure; often women, have a heart failure with preserved ejection fraction (HFpEF). They have severe symptoms with efort, frequent hospitalization, poor quality of life and high mortality. The prevalence of HFpEF is increasing while the prognosis is poor. Symptoms and signs will progress rapidly unless the triggering inflammatory process is treated. It should be kept in mind that HFpEF may have developed as a result of cytokine storm due to exacerbation of the underlying disease, especially in patients with rheumatological disease. The first sign of rheumatological disease may also be HFpEF. For this reason, it should be known that criteria other than EF will be important in the evaluation of patients presenting with heart failure symptoms. The treatment primarily includes treatment of the triggering factors, blood pressure control, and lifestyle changes.
Anahtar Kelimeler
Inflammation, cytokine storm, heart failure with preserved ejection fraction, mortality, treatment.
Kaynakça
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37 ( 27): 2129-200.
- Oren O, Goldberg S. Heart failure with preserved ejection fraction: diagnosis and management. Am J Med 2017; 130 ( 5): 510-6.
- Borlaug BA, Lam CSP, Roger VL, Rodeheffer RJ,Redfield MM. Contractility and ventricular systolic stiffening in hypertensive heart disease. J Am Coll Cardiol 2009; 54 (5): 410-8.
- Melenovsky V, Borlaug BA, Rosen B. et al. Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community. The role of atrial remodeling/dysfunction. J Am Coll Cardiol 2007; 49 (2): 198-207.
- Gorter TM, Hoendermis ES, van Veldhuisen DJ et al. Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur J Heart Fail 2016;18 (12): 1472-87.
- Lam CSP, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction. A community-based study. J Am Coll Cardiol 2009; 53 (13): 1119-26.
- Van Linthout S, Tschöpe C. Inflammation – Cause or consequence of heart failure or both? Curr Heart Fail Rep 2017; 14 (4): 251-65.
- Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 2013; 62 (4): 263-71.
- Torre-Amione G, Kapadia S, Benedict C, Oral H, Young JB, Mann DL. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: A report from the studies of left ventricular dysfunction (SOLVD). J Am Coll Cardiol 1996; 27 (5): 1201-6.
- Bozkurt D, Kılıç S. Kardiyo-immünoloji. In: Bozkurt D (ed). İç Hastalıklarında İmmün Sistem İlişkili Aciller. 1.Baskı. Ankara: Palme Yayınevi; 2019: 99-113.
- Thomas JT, Kelly RF, Thomas SJ. et al. Utility of history, physical examination, electrocardiogram, and chest radiograph for differentiating normal from decreased systolic function in patients with heart failure. Am J Med 2002; 112 (6): 437-45.
- Yusuf S, Pfeffer MA, Swedberg K. et al., Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: The CHARM-preserved trial. Lancet 2003; 362 (9386): 777-81.
- Forman D, Gaziano JM. Irbesartan in patients with heart failure and preserved ejection fraction. Curr Cardiovasc Risk Rep 2009; 3 (5): 311-2.
- Cleland JGF, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J. The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 2006; 27 (19): 2338-45.
- Pitt B, Pfeffer MA, Assmann SF,et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 2014; 370 (15): 1383-92.
- Flather MD, Shibata MC, Coats AJ, et al., FASTTRACK Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005; 26 (3): 215-25.
- Lam CSP, Voors AA, De Boer RA, Solomon SD, Van Veldhuisen DJ, Heart failure with preserved ejection fraction: From mechanisms to therapies. Eur Heart J 2018; 39 (30): 2780-92.
- Zandman-Goddard G, Blank M, Shoenfeld Y. Intravenous immunoglobulins in systemic lupus erythematosus: From the bench to the bedside. Lupus 2009; 18 (10): 884-88.
- Adamson PB, Abraham WT, Bourge RC, et al. Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Hear Fail 2014; 7 (6): 935-44.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Ocak 2021 |
| Gönderilme Tarihi | 6 Nisan 2020 |
| Yayımlandığı Sayı | Yıl 2021 |