p.22 抽出テキスト

Management of patients with HFrEF

LVEF ≤35% and QRS <130 ms and where appropriate (Class I) SR and LVEF ≤35% and

QRS ≥130 ms

If symptoms persist, consider therapies

with Class II recommendations

LVEF >35% or device therapy not indicated

or inappropriate

ACE-I/ARNIa Beta-blocker MRA Dapagliflozin/Empagliflozin Loop diuretic for fluid retention

Ischaemic

(Class I) Non-ischaemic

(Class IIa) ICD QRS ≥150 ms

(Class I) QRS 130–149 ms

(Class IIa)

CRT-Db/-P

Figure 2 Therapeutic algorithm of Class I Therapy Indications for a patient with heart failure with reduced ejection fraction. ACE-I =angiotensin-converting enzyme inhibitor; ARNI = angiotensin receptor-neprilysin inhibitor; CRT-D=cardiac resynchronization therapy with defibrillator; CRT-P= cardiac resynchronization therapy pacemaker; ICD= implantable cardioverter-defibrillator; HFrEF= heart failure with reduced ejection fraction; MRA= mineralocorticoid receptor antagonist; QRS= Q, R, and S waves of an ECG; SR = sinus rhythm. aAs a replacement for ACE-I. bWhere appropriate. Class I = green. Class IIa= Yellow.

Pharmacological treatments indicated in patients with (NYHA class II–IV) heart failure with reduced ejection fraction (LVEF <_40%)

Recommendations Classa Levelb

An ACE-I is recommended for patients with HFrEF to reduce the risk of HF hospitalization and death.110113 I A A beta-blocker is recommended for patients with stable HFrEF to reduce the risk of HF hospitalization and death.114120 I A An MRA is recommended for patients with HFrEF to reduce the risk of HF hospitalization and death.121,122 I A Dapagliflozin or empagliflozin are recommended for patients with HFrEF to reduce the risk of HF hospitalization and death.108,109 I A Sacubitril/valsartan is recommended as a replacement for an ACE-I in patients with HFrEF to reduce the risk of HF hospitalization and death.105 I B

ACE-I = angiotensin-converting enzyme inhibitor; HF = heart failure; HFrEF = heart failure with reduced ejection fraction; LVEF = left ventricular ejection fraction; MRA = mineralocorticoid receptor antagonist; NYHA = New York Heart Association. aClass of recommendation. bLevel of evidence. ESC 2021

5.3 Drugs recommended in all patients with heart failure with reduced ejection

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