2013年美国心力衰竭管理指南(心衰指南)-英文

age, and longer duration of hypertension. Long-term treatment of both systolic and diastolic hypertension reduces the risk of HF by approximately 50% (93-96). With nearly a quarter of the American population afflicted by hypertension and the lifetime risk of developing hypertension at >75% in the United States (97), strategies to control hypertension are a vital part of any public health effort to prevent HF.

Diabetes mellitus. Obesity and insulin resistance are important risk factors for the development of HF (98, 99). The presence of clinical diabetes markedly increases the likelihood of developing HF in patients without structural heart disease (100) and adversely affects the outcomes of patients with established HF (101, 102).

Metabolic syndrome. The metabolic syndrome includes any 3 of the following: abdominal adiposity,

hypertriglyceridemia, low high-density lipoprotein, hypertension, and fasting hyperglycemia. The prevalence of metabolic syndrome in the United States exceeds 20% of persons ≥20 years of age and 40% of those >40 years of age (103). The appropriate treatment of hypertension, diabetes mellitus, and dyslipidemia (104) can significantly reduce the development of HF.

Atherosclerotic disease. Patients with known atherosclerotic disease (e.g., of the coronary, cerebral, or

peripheral blood vessels) are likely to develop HF, and clinicians should seek to control vascular risk factors in such patients according to guidelines (13).

5. Cardiac Structural Abnormalities and Other Causes of HF

5.1. Dilated Cardiomyopathies

5.1.1. Definition and Classification of Dilated Cardiomyopathies

Dilated cardiomyopathy (DCM) refers to a large group of heterogeneous myocardial disorders that are

characterized by ventricular dilation and depressed myocardial contractility in the absence of abnormal loading conditions such as hypertension or valvular disease. In clinical practice and multicenter HF trials, the etiology of HF has often been categorized into ischemic or nonischemic cardiomyopathy, with the term DCM used interchangeably with nonischemic cardiomyopathy. This approach fails to recognize that “nonischemic

cardiomyopathy” may include cardiomyopathies due to volume or pressure overload, such as hypertension or valvular heart disease, which are not conventionally accepted as DCM (105). With the identification of genetic defects in several forms of cardiomyopathies, a new classification scheme based on genomics was proposed in 2006 (23). We recognize that classification of cardiomyopathies is challenging, mixing anatomic designations (i.e., hypertrophic and dilated) with functional designations (i.e., restrictive) and is unlikely to satisfy all users. The aim of the present guideline is to target appropriate diagnostic and treatment strategies for preventing the