射血分数正常的心力衰竭

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1、射血分数正常的心力衰竭中国医大一院心内科齐国先2010.06.06沈阳概念：1.HFSA,JCardFail.2006;12:1;2010.06.05沈阳2.OhJKetal.JAmCollCard.2006;47:500-506;22010.06.05沈阳3Epidemiology2010.06.05沈阳美国芬兰英国瑞典丹麦.西班牙葡萄牙荷兰(CHS)(Helsinki)(Poole)(Vasteras)(Copen.)(Asturias)(EPICA)(Rotter.)10左心室收缩功能降低的比55例951868HF-PEF的比例467716(%

2、59)5394患病3率C71H2F10年龄段66-10375-8670-847550>40>2555-95平均年龄78–7675–6068652010.06.05沈阳1.PetrieM,McMurrayJ.Lancet.2001;358:423-434.2.HoggKetal.JAmCollCard.2004;43:317-327.52010.06.05沈阳1.OwanTEetal.NEnglJMed.2006;355:251-259.62010.06.05沈阳BhatiaRSetal.NEnglJMed.2006;355:260-269.7201

3、0.06.05沈阳1.HoggKetal.JAmCollCard.2004;43:317-327.8临床特点2010.06.05沈阳症状和体征：收缩功能不全vs舒张功能不全2010.06.05沈阳GivertzMMetal.In:BraunwaldE,ZipesDP,LibbyP,eds.HeartDisease,ATextbookof心血管Medicine.7thedition.Philadelphia,Pa:WBSaunders.2001;534-561.12SandersonJE.Heart2007;93:155-158.13100EF尚正常7

4、58071EF降低635859575560504849(%)患40者20n=59783736170602167242988015700Olmsted1Framingham2CHS3Owan4Bhatia5n=CHF患者总人数1.SenniMetal.Circulation.1998;98:2282-2289.4.OwanTEetal.NEnglJMed.2006;355:251-2592.VasanRSetal.JAmCollCard.1999;33:1948-1955.5.BhatiaRSetal.NEnglJMed.2006;355:260-26

5、93.GottdienerJSetal.AnnInternMed.2002;137:631-63914病理生理机制舒张功能不全收缩功能不全高血压心梗、心肌病、高龄容量负荷过重左心室肥厚高血压向心性重构离心性重构左心室压力左心室容积调节剂:血管紧张素II,醛固酮,儿茶酚胺,细胞因子AdaptedfromZileMR,BrutsaertDL.Circulation.2002;105;1387-1393.16舒张功能不全的压力-容积环2010.06.05沈阳ImpairedVentricularRelaxation（心室松弛性下降）IncreasedVen

6、tricularStiffness（心室僵硬度增加）HypertrophyMyocardialischemiaHypertensionCollagendepositionRegionalasynchronyTachycardiaMyocardialinfiltration2010.06.05沈阳收缩期和舒张期时相2010.06.05沈阳诊断标准2010.06.05沈阳21222324舒张功能不全分期2010.06.05沈阳26B型脑钠肽，BNPMaiselA.S.,etal,fromtheDivisionofCardiologyandDepartme

7、ntofMedicine,Veteran’sAffairsMedicalCenterandUniversityofCalifornia,SanDiego:UtilityofB-natriureticpeptideasarapid,point-of-caretestforscreeningpatients2010.06.05沈阳undergoingechocardiographytodetermineleftventriculardysfunction.August2000.B型脑钠肽，BNPMaiselA.S.,etal,fromtheDivisio

8、nofCardiologyandDepartmentofMedicine,Veteran’sAffairsM