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Der Internist

, Volume 60, Issue 9, pp 925–942 | Cite as

Herzinsuffizienz mit erhaltener linksventrikulärer Ejektionsfraktion

  • Johannes Petutschnigg
  • Frank EdelmannEmail author
CME
  • 1.8k Downloads

Zusammenfassung

Die Herzinsuffizienz gilt als häufigste Einzeldiagnose von vollstationär behandelten Patienten in Deutschland. Für die Herzinsuffizienz mit erhaltener linksventrikulärer Ejektionsfraktion (HFpEF) hat sich etabliert, sie mit der Triade aus klinischen Symptomen, echokardiographischen Parametern und Biomarkern zu sichern oder auszuschließen. Aus ätiologischen und pathophysiologischen Gründen wurde die frühere Einteilung in systolische und diastolische Herzinsuffizienz weiterentwickelt zur Einteilung in Herzinsuffizienz mit reduzierter Ejektionsfraktion (HFrEF) und HFpEF. Die inhomogene Gruppe von Patienten mit HFpEF macht etwa die Hälfte des herzinsuffizienten Kollektivs aus. Wirksame Therapieoptionen sind sehr begrenzt. Der vorliegende Beitrag beschreibt, welche der geprüften Behandlungsansätze nutzen oder eventuell sogar schaden können. Es wird ein Ausblick in die Zukunft gewagt und beschrieben, welche Substanzen sich in der fortgeschrittenen klinischen Prüfung befinden.

Schlüsselwörter

Diastolische Herzinsuffizienz Diastolische Dysfunktion Diagnostik Therapie Prognose 

Heart failure with preserved left ventricular ejection fraction

Abstract

Heart failure remains the number one diagnosis among patients receiving inpatient treatment in Germany. Heart failure with preserved ejection fraction (HFpEF) needs to be verified by signs and symptoms of HF, echocardiographic parameters as well as cardiac biomarkers. Based on etiological and pathophysiological considerations, a classification into systolic and diastolic heart failure and later heart failure with reduced ejection fraction (HFrEF) and HFpEF was proposed. The inhomogeneous group of patients with HFpEF accounts for half of all heart failure cases in the population. Effective treatment options are limited. This article discusses which verified treatments may help or may even be harmful. A glimpse is taken into the future and those substances that are in advanced stages of clinical trials are described.

Keywords

Heart failure, diastolic Dysfunction, diastolic Diagnostic Therapy Prognosis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

Gemäß den Richtlinien des Springer Medizin Verlags werden Autoren und Wissenschaftliche Leitung im Rahmen der Manuskripterstellung und Manuskriptfreigabe aufgefordert, eine vollständige Erklärung zu ihren finanziellen und nichtfinanziellen Interessen abzugeben.

Autoren

F. Edelmann: A. Finanzielle Interessen: DZHK: Ex-VAD Studie, Spirit-HF Studie, Investitionsprogramm | DFG: Ex-DHF Studie | Servier: German HFpEF Registry | BMBF: Health 5G Projekt. – Speakers Bureau (Honorar und Kostenerstattung): Novartis, Servier, Berlin Chemie, Bayer, Merck, Boehringer Ingelheim, Amgen, Thermo Fisher, Resmed. – Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger o. ä.: Merck, Bayer, Cosmed, Novartis, Vifor Pharma. – B. Nichtfinanzielle Interessen: Oberarzt, Professor für kardiovaskuläre Prävention und klinische Herzinsuffizienzforschung, Facharzt für Innere Medizin, Kardiologie, Sportmedizin, Ärztliches Qualitätsmanagement, Medizinische Klinik mit Schwerpunkt Kardiologie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK) | Mitgliedschaften: DGK, DGIM, ESC, DEGUM, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Clinical Study Group (CSG) des DZHK | Mitglied und Sprecher der Working Group Clinical Research (WGCR) des DZHK. J. Petutschnigg: A. Finanzielle Interessen: J. Petutschnigg gibt an, dass kein finanzieller Interessenkonflikt besteht. – B. Nichtfinanzielle Interessen: Assistenzarzt für Innere Medizin und Kardiologie, Medizinische Klinik mit Schwerpunkt Kardiologie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK) | Mitgliedschaften: DGK, DGIM, ESC, DEGUM, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Working Group Clinical Research (WGCR) des DZHK.

Wissenschaftliche Leitung

Die vollständige Erklärung zum Interessenkonflikt der Wissenschaftlichen Leitung finden Sie am Kurs der zertifizierten Fortbildung auf www.springermedizin.de/cme.

Der Verlag erklärt, dass für die Publikation dieser CME-Fortbildung keine Sponsorengelder an den Verlag fließen.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Medizinische Klinik mit Schwerpunkt KardiologieCharité – Universitätsmedizin Berlin, Campus Virchow-KlinikumBerlinDeutschland
  2. 2.Standort BerlinDeutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)BerlinDeutschland
  3. 3.Berliner Institut für GesundheitsforschungCharité – Universitätsmedizin Berlin, Campus Virchow-KlinikumBerlinDeutschland

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