如何避免慢性心力衰竭恶化

Tohru Izumi, Toshimi Koitabashi, Mototsugu Nishii, Takayuki Inomata Department of Cardio-Angiology, Kitasato University School of Medicine, Sagamihara 288-8555, Japan Oct 23rd, 2008, Beijing, How to Prevent From Worsening of Chronic Heart Failure The 4 th China-Japan Cardiovascular Forum (CJCF) Chronic Heart Failure and Disease Burden Burden Aging CV Event CV Event BNP guided therapy for CHF patient Reduction of cardiac event (disease burden) Indicator: BNP CHF ACEI+BB Tx Comprehensive management Diuretics pg/mL scale * Plasma BNP level is titrated by RIA using Shionoria (Shionogi, Osaka) After discharge with/without BNP guided Follow up period after discharge (days) 1.0 0.6 0.8 0 0.2 0.4 0 200 400 600 Cardiac-event-free survival Clinical guided Tx BNP guided Tx p=0.0435 readmission rate 365 days 16.6% 31.5% In two years follow-up, there were significantly lower cardiac events, readmission, in BNP guided Tx in comparison with the clinical guided Tx. Cumulative rate of the event within one year reduced from 31.5 to 16.6%. Inomata T, et al. Jpn Circ J 2001;65 (S-1A), 282. Group I Group II SR SR Af Af Koitabashi T, Inomata T, et al. ESC 2004 BNP guided Tx cancelled out prognostic contribution by AF in CHF management Altered prognosis of Af Pts by introducing BNP guided Tx HF-event-free survival(%) Group II BNP guided era(00-02) Group I Clin guided era (96-98) SR group Af group Follow-up period(month) 380 pg/ml, n=14 BNP： 190 to 380 pg/ml, n=20 BNP： 190 Nishii M et al: JACC 51(24):2329-35, 2008 -5 0 5 10 15 20 25 30 The percentage change in LVDs (%)BNP 190pg/ml BNP 190pg/ml (LVDs at post-discharge 6 month LVDs at discharge) / LVDs at discharge x 100 P=0.003 205 -0.51 Six Months BNP Reverse Remodeling Summary 1. BNP guided therapy produces a superior and excellent outcome through physicians awareness toward their proper treatment. 2. However, the BNP measurement is not almighty diagnostic tool leading to comprehensive CHF management. 3. As a n