如何避免慢性心力衰竭恶化.ppt

TohruIzumi,ToshimiKoitabashi,MototsuguNishii,TakayukiInomataDepartmentofCardio-Angiology,KitasatoUniversitySchoolofMedicine,Sagamihara288-8555,Japan,Oct23rd,2008,Beijing,HowtoPreventFromWorseningofChronicHeartFailure,The4thChina-JapanCardiovascularForum(CJCF),ChronicHeartFailureandDiseaseBurden,BNPguidedtherapyforCHFpatient,Reductionofcardiacevent(diseaseburden),Indicator:BNP,CHF,ACEI+BBTx,Comprehensivemanagement,Diuretics,*PlasmaBNPlevelistitratedbyRIAusingShionoria(Shionogi,Osaka),Intwoyearsfollow-up,thereweresignificantlylowercardiacevents,readmission,inBNPguidedTxincomparisonwiththeclinicalguidedTx.Cumulativerateoftheeventwithinoneyearreducedfrom31.5to16.6%.,InomataT,etal.JpnCircJ2001;65(S-1A),282.,GroupI,GroupII,SR,SR,Af,Af,KoitabashiT,InomataT,etal.ESC2004,BNPguidedTxcancelledoutprognosticcontributionbyAFinCHFmanagement,AlteredprognosisofAfPtsbyintroducingBNPguidedTx,HF-event-freesurvival(%),GroupIIBNPguidedera(00-02),GroupIClinguidedera(96-98),BNPandArrhythmicPrognosis,KITASATOUNIVERSITY,Cost-effectivenessofBNPgTx,MorimotoT,IzumiT,FukuiTetal,IntJCardiol,2004,ClinicalIndicator,CheckPointforCHFManagement,Dry+Warm,BNP200,NewIndex?,Hospitalization,Lethal/Disability,Therapeuticplan,FundamentalTX,AdjunctiveTX,ReinforceTX,Default,LVAD/HTX,TotalBililbin,Care/Hospice,CardiacResynchronizationTherapy(CRT)vs.ReverseRemodeling,BeforeCRT,Twoweekslater,Oneyearlater,Echocardiogram（TMF）afterCRT,BeforeCRT,Oneyearlater,ReverseRemodelingand-Blocker（Carvedilol）,DilatedCardiomyopathyvs.ReverseRemodeling,ImmunohistochemicalStainingforNFB,WohlschlaegerJ,BabaAHetal,CardiovasRes、2005,ClinicalIndicator,CheckPointforCHFManagement,Dry+Warm,BNP200,ReverseRemodeling,Hospitalization,Lethal/Disability,Therapeuticplan,FundamentalTX,AdjunctiveTX,ReinforceTX,Default,LVAD/HTX,TotalBililbin,Care/Hospice,Anti-RemodelingandReverseRemodeling,Mancinid&Burkhoff，Circulation,2005,AcuteHeartFailure,ChronicHeartFailure,PrimaryEndpoint(J-WIND),EjectionFraction(EF)inChronicStage,Control,（,（,n=187,n=187,）,）,Nicorandil,（,（,n=190,n=190,）,）,p=0.460,p=0.460,36,36,40,40,44,44,48,48,0,0,(%),(%),Control,（,（,n=199,n=199,）,）,ANP,（,（,n=155,n=155,）,）,36,36,40,40,44,44,48,48,0,0,(%),(%),p=0.024,p=0.024,左,左,室,室,駆,駆,出,出,率,率,hANP,Nicorandil,左,左,室,室,駆,駆,出,出,率,率,43.2%,42.5%,44.7%,42.5%,ThePREAMIInvestigators,ArchInternMed2006,Anti-remodeling&Perindopril,In,SixMonthsBNP&CVEvents,NishiiMetal:JACC51(24):2329-35,2008,SixMonthsBNP&ReverseRemodeling,LVEF,atdischarge,at6months,P=0.005,atdischarge,at6months,LVDd,NishiiMetal:JACC51(24):2329-35,2008,SixMonthsBNPReverseRemodeling,SummaryBNPguidedtherapyproducesasuperiorandexcellentoutcomethroughphysiciansawarenesstowardtheirpropertreatment.However,theBNPmeasurementisnotalmightydia