Оценка фракции выброса и сократительная функция левого желудочка: насколько этот параметр точен?

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).

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