充血性心力衰竭PPT课件.ppt

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1、CongestiveHeartFailureCollaborative,October14,2004PreventingReadmissionsKennethA.LaBresh,MD,FAHA,FACCV.P.,MedicalAffairsandQualityImprovement,MassPROClinicalAssociateProfessor,BrownUniversityACC/AHAGuidelinesforEvaluationandManagementofChronicHeartFailure2001HFcanbepreve

2、ntedHFhasestablishedriskfactorsHFisaprogressiveconditionwithasymptomaticandsymptomaticstagesHFmorbidityandmortalitycanbereducedbystagespecifictreatmentsHunt,etal.JAmCollCardiol.2001;38:2101-2113.ACC/AHAProposedStagesofHFSTAGEAHighriskfordevelopingHFSTAGEBAsymptomaticLVdy

3、sfunctionSTAGECPastorcurrentsymptomsofHFSTAGEDEnd-stageHFHunt,etal.JAmCollCardiol.2001;38:2101-2113.NeurohormonalActivationinHeartFailureHypertrophy,apoptosis,ischemia,arrhythmias,remodeling,fibrosisAngiotensinIINorepinephrineMorbidityandMortalityCNSsympatheticoutflow

4、CardiacsympatheticactivityRenalsympatheticactivitySodiumretentionMyocytehypertrophyMyocyteinjuryIncreasedarrhythmiasDiseaseprogression1b1b1b21VascularsympatheticactivityVasoconstriction1ActivationofRASAdrenergicPathwayinHeartFailureProgressionBeta-blockerTherapyinHe

5、artFailurePotentialBeneficialEffectsProtectionfromCatecholamineToxicityReninAngiotensinSystemReversalofRemodelingUp-regulationofb-adrenergicReceptorsAncillaryFactorsMajorPlaceboControlledTrialsof-BlockadeinHeartFailure34%CumulativeMortality(%)Days20155010P=.0062(adjust

6、ed)MetoprololCR/XL(n=1990)Placebo(n=2001)USCarvedilolTrials1ProbabilityofEvent-freeSurvivalCarvedilol(n=696)Placebo(n=398)DaysP<.0010.0010020030040065%1.00.80.70.9MERIT-HF2Survival(%ofPatients)1009080607006000400300200100DaysCarvedilol(n=1156)Placebo(n=1133)50060004003

7、0020010050035%P=.00013COPERNICUS4Days0.02004008001.00.80.6P<.000134%Bisoprolol(n=1327)Placebo(n=1320)CIBIS-II30600Survival1PackerMetal.NEnglJMed.1996;334:1349–1355.2MERIT-HFStudyGroup.Lancet.1999;253:2001–2007.3CIBIS-IIInvestigators.Lancet.1999;353:9–13.4PackerMetal.NE

8、nglJMed.2001;344:1651–1658.COPERNICUS:All-CauseMortality%Survival10090806070502402016128428MonthsAllpat