射血分数正常的心衰-课件

1、66-10375-8670-847550402555-95787675606865年龄段平均年龄美国 (CHS)芬兰(Helsinki)英国(Poole)丹麦. (Copen.)西班牙 (Asturias)葡萄牙(EPICA)荷兰 (Rotter.)瑞典(Vasteras)左心室收缩功能降低的比例HF-PSF的比例55516846715939711. Petrie M, McMurray J. Lancet. 2001;358:423-434. 2. Hogg K et al. J Am Coll Card. 2004;43:317-327.CHF患病率患病率 (%)012345678910正

2、常正常收缩性心衰收缩性心衰HFNEFAurigemma, Zile, GaaschCirculation 2005LVEF45%LVEDVI15或或E/E 8 + NT-proBNP220pg/ml3LVEDP16mmHgPCWP12mmHgHF的症状或体征LVEF 45% 且 左心室舒张末期容积指数(LVED VI) 12 mmHg或左心室舒张末压16 mmHg组织多普勒NT proBNP 220 pg/mlBNP 200 pg/mlE/E 1515 E/E 8超声血流多普勒 :. E/A DT. 肺静脉血流. 左房扩大 . LVMI. 房颤NT proBNP 220 pg/mlor BNP

3、 200 pg/mlHFNEF组织多普勒E / E 8 培哚普利培哚普利2mg安慰剂安慰剂n=426n=424Cleland JG. Eur Heart J. 2006;27:2338-2345.HF hospitalization Cleland, et al. Eur Heart J. 2006; 27:2338-2345. Death and HF hospitalization37069Placebo3Pt. at riskPerindoprilPlacebo012424426374356184186Perindopril1 yr =HR 0.6995% CI 0.47-1.01P=0

4、.055Overall:HR 0.9295% CI 0.70-1.21 P=0.545Time (y)Proportion having an event (%)403020100012PerindoprilTime (y)42442637435618418670690123PerindoprilPlacebo1 yr =HR 0.6395% CI 0.41-0.97P=0.033Overall:HR 0.85995% CI 0.614-1.202P=0.375Time (y)403020100Proportion having an event (%)Time (y)Yusuf S et a

5、l. Lancet 2003;362:777-781.Number at RiskCandesartanPlacebo单独使用ARB组1013101583179843442712212692988710131015831798434427122126929887504000233.5Time (Years)3020101504000233.5Time (Years)3020101PlaceboCandesartanProportion with CV Death oror Hospitalization for CHF23% RR, p = 0.0004ACEI+ARB组12761272106

6、310139489064574221176113612761272106310139489064574221176113650400Time (Years)302010233.510233.51PlaceboCandesartanProportion with CV Death oror Hospitalization for CHF15% RR, p = 0.01左室舒张功能不全组1514150913771359833824182195145814411514150913771359833824182195145814410233.5Time (Years)10233.5Time (Year

7、s)1PlaceboCandesartanProportion with CV Death oror Hospitalization for CHF11% RR, p = 0.1250400302010504003020100123years3.50102030PlaceboCandesartan51525HR 0.89 (95% CI 0.77-1.03), p=0.118Adjusted HR 0.86, p=0.051 %366 (24.3%)333 (22.0%)Yusuf S et al. Lancet. 2003;362:777781.Number at riskCandesart

8、an 1514 1458 1377 833 182Placebo 1509 1441 1359 824 195CV death, CHF hosp.333 366 - CV death170170 -CHF hosp. 241276CV death, HF hosp,365399 MI CV death, HF hosp,388429 MI, stroke CV death, HF hosp,460497 MI, stroke, revasc candesartan betterHazard ratioplacebo better0.81.01.2p-value0.9180.0720.1180.1260.0780.123Covariat