medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-384medsovet-8618Research ArticleХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬCHRONIC HEART FAILUREОценка фракции выброса и сократительная функция левого желудочка: насколько этот параметр точен?Ejection fraction assessment and left ventricular contractile function: How accurate is this parameter?https://orcid.org/0000-0002-5684-9842ГвоздеваА. Д.GvozdevaA. D.

Гвоздева Анна Дмитриевна, врач функциональной диагностики

109240, Москва, ул. Яузская, д. 11/6

Anna D. Gvozdeva

11/6, Yauzskaya St., Moscow, 109240

gvozdevaannalech@gmail.comhttps://orcid.org/0000-0003-4027-3727ЗакиевВ. Д.ZakievV. D.

Закиев Вадим Дмитриевич, младший научный сотрудник лаборатории клинической фармакологии и фармакотерапии Российского геронтологического научно-клинического центра

129226, Москва, ул. 1-я Леонова, д. 16

Vadim D. Zakiev, Junior Researcher, Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontological Research and Clinical Center

16, 1st Leonov St., Moscow, 129226

zakiev739@gmail.comhttps://orcid.org/0000-0002-8505-1848ГиляревскийС. Р.GilyarevskiyS. R.

Гиляревский Сергей Руджерович, д.м.н., профессор, ведущий научный сотрудник лаборатории сердечно-сосудистого старения Российского геронтологического научно-клинического центра

129226, Москва, ул. 1-я Леонова, д. 16

Sergey R. Gilyarevskiy, Dr. Sci. (Med.), Professor, Leading Researcher, Laboratory of Cardiovascular Aging, Russian Gerontological Research and Clinical Center

16, 1st Leonov St., Moscow, 129226

21sgilarevsky@rambler.ruГородская клиническая больница имени И.В. ДавыдовскогоРоссияDavydovsky Moscow City Clinical HospitalRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202430102024016108113Copyright © Гвоздева А.Д., Закиев В.Д., Гиляревский С.Р., 20242024Гвоздева А.Д., Закиев В.Д., Гиляревский С.Р.Gvozdeva A.D., Zakiev V.D., Gilyarevskiy S.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8618

Оценка фракции выброса (ФВ) левого желудочка (ЛЖ) относится к важным компонентам диагностики сердечной недостаточности (СН) и принятия решения о тактике лечения пациентов с СН. В клинической практике для оценки систолической функции ЛЖ и ФВ ЛЖ обычно используется эхокардиография, прежде всего в связи с ее простотой и доступностью, однако данный метод имеет ряд ограничений, к которым относят в первую очередь межисследовательскую и внутриисследовательскую вариабельность результатов, зависимость от качества визуализации и др. Результаты исследований, в ходе выполнения которых изучали эффекты применения различных лекарственных средств при СН и сохраненной ФВ ЛЖ, свидетельствовали о различиях эффективности препаратов в зависимости от величины ФВ ЛЖ. Такие результаты позволяют предположить, что препараты базовой терапии СН и сниженной ФВ ЛЖ сохраняют свою эффективность при СН и сохраненной ФВ ЛЖ, если у них имеются признаки нарушения не только диастолической, но и систолической функции. Таким образом, ФВ ЛЖ может быть недостаточно надежным критерием для выбора терапии. В связи с этим очевидна необходимость внедрения в клиническую практику дополнительных маркеров для оценки систолической функции ЛЖ. Целью данного обзора было обсуждение трудностей оценки и клинической интерпретации систолической функции ЛЖ с помощью эхокардиографии и возможностей альтернативных диагностических методов, в частности деформации миокарда (спекл-трекинг-эхокардиография).

Evaluation of the left ventricular (LV) ejection fraction (EF) is a key component for diagnosis and treatment of heart failure (HF). Echocardiography is commonly used to assess LV systolic function and LV EF due to its simplicity and availability. However, it has some limitations, including interand intra-observer variability, dependence on the quality of visualization, etc. HF trials showed that there are some differences in the HF therapy effectiveness depending on the value of LV EF. These results suggest that basic therapy for HF and reduced LVEF is also effective in HF and preserved LVEF if patients have impairment of not only diastolic but also systolic function. Thus, LVEF may not be a reliable parameter to guide treatment decisions andit is necessary to introduce additional markers into clinical practice to assess LV systolic function. The purpose of this review is to discuss the difficulties of assessing LV systolic function using echocardiography and the possibilities of using alternative diagnostic methods, in particular myocardial deformation (speckle tracking echocardiography).

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The authors declare that there are no conflicts of interest present.