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ID:208467
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时间:2017-07-03
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1、ManagementofSystolicvs.DiastolicHeartFailureMichaelWolk,MD,FACCWeill-CornellGreatWallofChinaSymposiumOctober,2004Basicconcepts…TheclinicalsyndromeofheartfailurecanoccurwitheithernormalorreducedLVEFVirtuallyallclinicaltrialsofheartfailuretherapieshaveenrolledonlypatientswithred
2、ucedLVEFThus…ExtrapolatingrecommendedtherapyforHFwithreducedEFtopatientswithHFandnormalEFisnot“automatic”TherapyforHFwithReducedEFEvidencebaseforACEIandbetablockertherapyamongthelargestandmostconsistentinmedicinediureticdigoxindiureticdigoxinACEIdiureticdigoxinACEIdiureticdigo
3、xinACEIBetablockerdiureticdigoxinACEIBetablockerdiureticdigoxinACEIBetablockerARBSOLVD-T(1991)RRR21%CIBIS-2(1999)RRR33%CHARM-Added(2003)(Beta-blockersubgroup)RRR30%ImprovingSurvivalinCHFOne-yearMortalityCVDeath,MI,orHFbyTreatmentPfeffer,McMurray,Velazquez,etal.NEnglJMed2003;3
4、49CaptoprilMonthsValsartanvs.Captopril:HR=0.96;P=0.198Valsartan+Captoprilvs.Captopril:HR=0.97;P=0.36900.10.20.30.4061218243036ProbabilityofEventValsartanValsartan+CaptoprilACE-IinHF-WhoandHow?HFSAPracticeGuidelines2004Allpts(symptomaticandasymptomatic)withLVsystolicdysfunction
5、(LVEF<40%).ACEIshouldbemonitoredcloselyifserumCris>2.0mg/dlorserumpotassiumis>5.0mmol/L.ACEIshouldbetitratedastolerated,inconjunctionwithBBs,totargetdosesusedinclinicaltrials.WeightOfEvidence:-BlockadeOver18,000patientsevaluatedinlong-termplacebo-controlledclinicaltrialsImpro
6、vementincardiacfunctionandsymptoms;(equivocaleffectsonexercisetolerance)Decreaseinall-causemortalityby30%-35%(P<.0001);effectshownin5individualtrialsDecreaseincombinedriskofdeathandhospitalizationby35%-40%(P<.001);effectshownin7individualtrialsEffectshowninpatientsalreadyrecei
7、vingACEinhibitorsTherapyforHFwithReducedEFLifestylechanges:SaltrestrictionAchieveidealweightPursueregularexerciseAvoidsmoking,toxinsTherapyforHFwithReducedEFGeneralconsiderationsforallpatientsTreatreversibleischemiaManagecontributingarrhythmiaWHATHAVEWELEARNEDABOUTNESIRITIDEI
8、NCHF?Asimpleregimen/predictableeffect.Improveshemodynamics.Im
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