Right Atrial Strain as a Surrogate Marker for Right Ventricular Function in Patients with Heart Failure

摘要

Guideline-directed medical therapy (GDMT) is an especially important part of the treatment of patients with heart failure (HF) and should be applied to all patients possible.1) In particular, physicians must understand the guidelines for starting or changing medication and decide which treatment is appropriate for each patient, especially in patients hospitalized for acute heart failure (AHF). AHF can be defined as new-onset or worsening of symptoms and signs of HF, and outcomes of AHF remain globally poor.2),3),4) Therefore, the treatment strategy for improving outcomes of patients with AHF should be optimized and personalized on the continuous line of chronic HF. Patients presenting or suspected with AHF should undergo rapid triage and appropriate treatment for possible cardiogenic shock, respiratory failure, myocardial infarction and/or arrhythmia.2),5) After that, treatment should then be tailored and optimized according to phenotype, pathophysiology, precipitants, pathology, poly-morbidity, potential harm and preferences.6) In this respect, hospitalization in patients with HF and reduced ejection fraction provides a good opportunity to re-address GDMT, and pre-discharge initiation of GDMT is associated with improved prognosis and reduced re-admission rate. The key factors physicians must carefully consider are drug selection and timing of administration, which should be decided according to the patient's condition and symptoms. AHF patients that display evidence of congestion should receive decongestive treatment such as vasodilators and/or diuretics.7),8) While diuretics are mainly used in the presence of fluid overload, vasodilators are administered to reduce filling pressures in the presence of fluid redistribution and preserved systolic blood pressure. Inappropriate use of inotropic agents is associated with increased morbidity and mortality; therefore, inotropes should be reserved only for patients with cardiogenic shock due to impaired myocardial contractility.9) In cases of persistent hemodynamic instability despite escalating doses of inotropes, mechanical circulatory support such as veno-arterial extracorporeal life support and percutaneous left-ventricular assist devices should be considered before irreversible organ failure.10)