Skip to main content
SpringerLink
Log in

Diagnostik und Therapie der Herzinsuffizienz

Diagnostics and therapy of heart failure

  • CME Zertifizierte Fortbildung
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Die Herzinsuffizienz stellt mit einer geschätzten Prävalenz von 0,4–2% in Europa eine der häufigsten Erkrankungen der westlichen Welt dar. Häufigkeit und Inzidenz sind stark altersabhängig, und die chronische Herzinsuffizienz hat stadienabhängig eine hohe Sterblichkeit. Diagnostik und Therapie der chronischen Herzinsuffizienz unterliegen einem stetigen Wandel, bedingt zum einen durch die Fortschritte in der Forschung und zum anderen durch neue randomisierte Studien. Diese Übersichtsarbeit fasst alle aktuellen Empfehlungen zur Diagnostik und Therapie der chronischen Linksherzinsuffizienz zusammen. Dabei werden Erkenntnisse bei den kardialen Biomarkern, der Echokardiographie, der Spiroergometrie und den bildgebenden Verfahren kritisch diskutiert und innovative Therapieansätze wie Ivabradin oder die medikamentöse Therapie der pulmonalen Hypertonie bei Linksherzinsuffizienz vorgestellt. Neben den medikamentösen Strategien werden auch potenzielle Device-Therapien wie MitraClip®, operative Maßnahmen und die Herztransplantation erörtert.

Abstract

Heart failure represents one of the most common diseases in the western world with an estimated prevalence of 0.4-2% in Europe. The frequency and incidence is very age-dependant and chronic cardiac insufficiency has a high stage-dependant mortality. Aging of the population and prolongation of the lives of cardiac patients has led to an increasing prevalence of heart failure. However, average survival remains poor after hospitalization for a first episode of heart failure. Diagnostics and therapy of heart failure are subject to constant change due to ongoing progress in research and new randomized controlled trials. This review will focus on new developments and current guidelines for diagnosis and treatment of heart failure. Findings on natriuretic peptides and echocardiography in patients with preserved ejection fraction will be presented and innovative therapeutic measures, such as ivabradine will be discussed. Besides new drug developments insight into device therapy, such as MitraClip® and operative approaches for heart failure will be presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442

    Article  PubMed  CAS  Google Scholar 

  2. Rottlaender D, Michels G, Hoppe UC (2008) Natriuretic peptides – when should they be used in heart failure? Dtsch Med Wochenschr 133:196–200

    Article  PubMed  CAS  Google Scholar 

  3. Schulz R, Blau A, Borgel J et al (2007) Sleep apnoea in heart failure. Eur Respir J 29:1201–1205

    Article  PubMed  CAS  Google Scholar 

  4. Anonymous (1991) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N Engl J Med 325:293–302

    Article  Google Scholar 

  5. Pitt B, Poole-Wilson PA, Segal R et al (2000) Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial – the Losartan Heart Failure Survival Study ELITE II. Lancet 355:1582–1587

    Article  PubMed  CAS  Google Scholar 

  6. McMurray JJ, Ostergren J, Swedberg K et al (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 362:767–771

    Article  PubMed  CAS  Google Scholar 

  7. Yusuf S, Teo KK, Pogue J et al (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358:1547–1559

    Article  PubMed  CAS  Google Scholar 

  8. CIBIS-II Investigators (1999) The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 353:9–13

    Article  Google Scholar 

  9. MERIT-HF Study Group (1999) Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 353:2001–2007

    Article  Google Scholar 

  10. Pitt B, Zannad F, Remme WJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 341:709–717

    Article  PubMed  CAS  Google Scholar 

  11. Zannad F, McMurray JJ, Krum H et al (2011) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364:11–21

    Article  PubMed  CAS  Google Scholar 

  12. Digitalis Investigation Group (1997) The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 336:525–533

    Article  Google Scholar 

  13. Hood WB Jr, Dans AL, Guyatt GH et al (2004) Digitalis for treatment of congestive heart failure in patients in sinus rhythm: a systematic review and meta-analysis. J Card Fail 10:155–164

    Article  PubMed  CAS  Google Scholar 

  14. Anker SD, Comin Colet J, Filippatos G et al (2009) Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 361:2436–2448

    Article  PubMed  CAS  Google Scholar 

  15. Swedberg K, Komajda M, Bohm M et al (2010) Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 376:875–885

    Article  PubMed  CAS  Google Scholar 

  16. Rosenkranz S, Bonderman D, Buerke M et al (2011) Pulmonary hypertension due to left heart disease: updated Recommendations of the Cologne Consensus Conference 2011. Int J Cardiol 154(Suppl 1):S34–S44

    Article  PubMed  Google Scholar 

  17. Connolly SJ, Camm AJ, Halperin JL et al (2011) Dronedarone in high-risk permanent atrial fibrillation. N Engl J Med 365:2268–2276

    Article  PubMed  CAS  Google Scholar 

  18. Moss AJ, Hall WJ, Cannom DS et al (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 335:1933–1940

    Article  PubMed  CAS  Google Scholar 

  19. Bristow MR, Saxon LA, Boehmer J et al (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150

    Article  PubMed  CAS  Google Scholar 

  20. Cleland JG, Daubert JC, Erdmann E et al (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539–1549

    Article  PubMed  CAS  Google Scholar 

  21. Linde C, Gold M, Abraham WT, Daubert JC (2006) Rationale and design of a randomized controlled trial to assess the safety and efficacy of cardiac resynchronization therapy in patients with asymptomatic left ventricular dysfunction with previous symptoms or mild heart failure – the REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) study. Am Heart J 151:288–294

    Article  PubMed  Google Scholar 

  22. Moss AJ, Hall WJ, Cannom DS et al (2009) Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 361:1329–1338

    Article  PubMed  Google Scholar 

  23. Ferreira AM, Adragao P, Cavaco DM et al (2008) Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation. Europace 10:809–815

    Article  PubMed  Google Scholar 

  24. Franzen O, Heyden J van der, Baldus S et al (2011) MitraClip® therapy in patients with end-stage systolic heart failure. Eur J Heart Fail 13:569–576

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Universitätsklinik II für Innere Medizin, Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 38, A-5020, Salzburg, Österreich

    R. Steinacher, D. Rottlaender &  U.C. Hoppe

Authors
  1. R. Steinacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Rottlaender
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U.C. Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U.C. Hoppe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steinacher, R., Rottlaender, D. & Hoppe, U. Diagnostik und Therapie der Herzinsuffizienz. Herz 37, 543–554 (2012). https://doi.org/10.1007/s00059-012-3638-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-012-3638-5

Schlüsselwörter

Keywords

Search

Navigation