Dtsch Med Wochenschr 2020; 145(19): 1369-1376
DOI: 10.1055/a-1040-1158
Dossier

Diagnostische Herausforderungen bei Herzinsuffizienz

Update on the diagnosis of HFrEF and HFpEF
Stefanie M. Werhahn
,
Rolf Wachter

Die Herzinsuffizienz ist der häufigste Grund für eine vollstationäre Behandlung in Deutschland. Während die Diagnosestellung bei der Herzinsuffizienz mit reduzierter Ejektionsfraktion („HFrEF“) unstrittig ist, stellt sie bei der Herzinsuffizienz mit erhaltener Ejektionsfraktion („HFpEF“) eine Herausforderung dar. Zwei kürzlich veröffentlichte neue Diagnoseschemata zur HFpEF sollen im Folgenden vorgestellt werden.

Abstract

Heart failure (HF) is the leading cause for inpatient treatment in Germany. Its diagnosis is based on the ESC Guidelines for Diagnosis and Treatment of Heart Failure of 2016. More than half of all patients with HF suffer from HF with preserved ejection fraction (HFpEF), whose diagnosis is still challenging. Two new diagnostic scores have been proposed to facilitate the diagnosis of HFpEF and are presented in this article, the H2FPEF-Score and the HFA-PEFF-algorithm by the Heart Failure Association.



Publication History

Article published online:
24 September 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Literatur

  • 1 Deutsche Herzstiftung e. V.. Deutscher Herzbericht 2018. Frankfurt am Main: Deutsche Herzstiftung e. V.. Im Internet (Stand: 30.06.2020): https://www.herzstiftung.de/herzbericht
  • 2 Häufigste Diagnosen in Prozent der Behandlungsfälle in Arztpraxen in Nordrhein (Primärquelle: Zentralinstitut für kassenärztliche Versorgung). Im Internet (Stand: 20.03.2020): http://www.gbe-bund.de
  • 3 Ponikowski P, Voors AA, Anker SD. 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 Heart J 2016; 37: 2129-2200 . doi:10.1093/eurheartj/ehw128
  • 4 Harjola VP, Costa S, Sund R. et al The type of acute heart failure and the costs of hospitalization. Int J Cardiol 2010; 145: 103-105 . doi:10.1016/j.ijcard.2009.05.058
  • 5 Fröhlich G, Schorn K, Fröhlich H. Dyspnoe. Internist (Berl) 2020; 61: 21-35 . doi:10.1007/s00108-019-00720-z
  • 6 van Riet EE, Hoes AW, Limburg A. et al Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail 2014; 16: 772-777 . doi:10.1002/ejhf.110
  • 7 Leistner DM, Klotsche J, Pieper L. et al Prognostic value of NT-pro-BNP and hs-CRP for risk stratification in primary care: results from the population-based DETECT study. Clin Res Cardiol 2013; 102: 259-268 . doi:10.1007/s00392-012-0530-5
  • 8 Roberts E, Ludman AJ, 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
  • 9 Charron P, Arad M, Arbustini E. et al Genetic counselling and testing in cardiomyopathies: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2010; 31: 2715-2726 . doi:10.1093/eurheartj/ehq271
  • 10 Steinberg BA, Zhao X, Heidenreich PA. et al Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation 2012; 126: 65-75 . doi:10.1161/CIRCULATIONAHA.111.080770
  • 11 van Riet EE, Hoes AW, Wagenaar KP. 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: 242-252 . doi:10.1002/ejhf.483
  • 12 Santhanakrishnan R, Wang N, Larson MG. et al Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction. Circulation 2016; 133: 484-492 . doi:10.1161/CIRCULATIONAHA.115.018614
  • 13 Kirchhof P, Benussi S, Kotecha D. et al 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893-2962 . doi:10.1093/eurheartj/ehw210
  • 14 Reddy YNV, Carter RE, Obokata M. et al A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction. Circulation 2018; 138: 861-870 . doi:10.1161/CIRCULATIONAHA.118.034646
  • 15 Pieske B, Tschope C, de Boer RA. et al How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2019; 40: 3297-3317 . doi:10.1093/eurheartj/ehz641
  • 16 Barandiaran Aizpurua A, Sanders-van Wijk S, Brunner-La Rocca HP. et al Validation of the HFA-PEFF score for the diagnosis of heart failure with preserved ejection fraction. Eur J Heart Fail 2020; 22: 413-421 . doi:10.1002/ejhf.1614
  • 17 Konstam MA, Kiernan MS, Bernstein D. et al Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2018; 137: e578-e622 . doi:10.1161/CIR.0000000000000560
  • 18 Harjola VP, Mebazaa A, Celutkiene J. et al Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail 2016; 18: 226-241 . doi:10.1002/ejhf.478
  • 19 Pilarczyk K, Renner J, Haake N. [Acute right heart failure on the intensive care unit: Pathophysiology, monitoring and management]. Med Klin Intensivmed Notfmed 2019; 114: 567-588 . doi:10.1007/s00063-019-0603-6