Роль левого предсердия в патогенезе сердечной недостаточности с сохраненной фракцией выброса

Дисфункция левого предсердия (левопредсердная миопатия) не только является следствием нарушения диастолической функции левого желудочка, но и играет центральную роль в патофизиологии сердечной недостаточности с сохраненной фракцией выброса (СНсФВ). Левопредсердная миопатия при СНсФВ ассоциируется с более тяжелым течением сердечной недостаточности и неблагоприятным прогнозом, и от ее выраженности во многом зависит выбор лечения. Эхокардиография позволяет точно оценить состояние левого предсердия, при этом показатели деформации его миокарда чувствительны к начальным функциональным нарушениям, позволяют улучшить диагностику СНсФВ и определить прогноз. В статье рассматриваются участие левого предсердия в наполнении левого желудочка, его статус при различных стадиях диастолической дисфункции левого желудочка, основные механизмы развития предсердной миопатии при СНсФВ и лечебные подходы к ее сдерживанию и реверсии.

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