《舒张性心力衰竭》PPT课件

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1、ClinicalAspectsofDiastolicHeartFailureShin-ichiMomomura,MDCardiovascularCenterToranomonHospitalTokyo,JapanIncidenceofHeartFailureFraminghamHeartStudyJAmCollCardiol1993;22:6A–13AMaleFemaleDistributionofLeftVentricularEjectionFraction:EuroHeartFailureS

2、urveyEuropeanHeartJournal(2003)24,442–463WhatisDiastolicHeartFailure?Diastolic(Heart)FailureHeartfailureduetodiastolicdysfunctionHeartFailurewithPreservedorNormalSystolicFunctionCf)SystolicHeartFailure≒CausesofDiastolicDysfunctionLeftventricularhypert

3、rophy(common)AorticstenosisChronichypertensionHypertrophiccardiomyopathy(with/wothoutoutflowtractobstruction)Acuteepisodicmyocardialischemica(common)Pericardialdisease(rare)TamponadeConstrictionConstrictive-effusivediseaseduetopriorradiationtherapyRes

4、trictivecardiomyopathy(rare)AmyloiddiseaseIdiopathicrestrictivecardiomyopathyMechanismofDHFLVdiastolicdysfunction↓CONeurohormnalactivityExersionaldyspnea↓strokevolumeSodium/waterretension↑LVfillingpressureedemaPulmonaryedemaPulmonarycongestioncAcuteel

5、evationofBPEpidemiologyofDHFPrevalenceofDHFDiagnosticCriteriaEvaluationofLVfunctionPrevalenceGhaliFHSFS>24%(UCG)28%TaffetFHSEF>45%(RNV)43%TakaradaFHSFS>30%(UCG)24%VasanFHSEF>50%(UCG)51%Distributionoftheseverityofleftventricularsystolicdysfunctionbyqu

6、alitativeassessmentWomenMenEuropeanHeartJournal(2003)24,442–463PrognosisofDHFandSHF(1)EF＜50%EF≧50%7859584451354432362916151.00.80.60.40.001234560.2ExpectedEF＜50%EF≧50%SurvivalYearsSenniM.etal.：Circulation,98,2282,1998.P=0.279PrognosisofDHFandSHF(2)Smi

7、thGL.JACC2003;41:1510-8Characteristics:DemographicPreservedEF(n=200)DepressedEF(n=213)pValueAge73+1170+110.004Malegender74(37%)139(65%)0.001Whiterace158(79%)159(75%)0.30SmithGL.JACC2003;41:1510-8Characteristics:CardiacHistoryPreservedEF(n=200)Depresse

8、dEF(n=213)pValueEF60+828+100.0001HF128(64%)169(79%)0.001Previous.hospitalizationforHF60(30%)94(45%)0.002YearsofHF2.4+5.43.3+5.50.002Hypertension160(80%)139(65%)0.001Arrhythmia77(39%)112(53%)0.004Pacemakerplacement20(10%)40(19%)0.01SmithGL.JACC