如何避免慢性心力衰竭恶化课件

1、Tohru Izumi, Toshimi Koitabashi, Mototsugu Nishii, Takayuki InomataDepartment of Cardio-Angiology, Kitasato University School of Medicine, Sagamihara 288-8555, JapanOct 23rd, 2008, Beijing,How to Prevent From Worsening of Chronic Heart Failure The 4 th China-Japan Cardiovascular Forum (CJCF) Chronic

2、 Heart Failure and Disease BurdenBurdenAgingCV EventCV EventBNP guided therapy for CHF patientReduction of cardiac event (disease burden)Indicator: BNPCHFACEI+BB TxComprehensive managementDiuretics pg/mL scale* Plasma BNP level is titrated by RIA using Shionoria (Shionogi, Osaka)After discharge with

3、/without BNP guidedFollow up period after discharge (days)1.00.60.800.20.40200400600Cardiac-event-free survivalClinical guided TxBNP guided Txp=0.0435readmission rate365 days16.6%31.5%In two years follow-up, there were significantly lower cardiac events, readmission, in BNP guided Tx in comparison w

4、ith 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 IGroup IISRSRAfAfKoitabashi T, Inomata T, et al. ESC 2004BNP guided Tx cancelled out prognostic contribution by AF in CHF managementAltered progn

5、osis of Af Pts by introducing BNP guided Tx HF-event-free survival(%)Group IIBNP guided era(00-02)Group IClin guided era (96-98)SR groupAf groupFollow-up period(month)200pg/mL200pg/mLEvent free survival0.00.10.20.30.40.50.60.70.80.91.00102030405060708090Follow-up period (months)Event free survival0.

6、00.10.20.30.40.50.60.70.80.91.00102030405060708090Follow-up period (months)P0.0001Total deathArrhythmic eventsBNP100pg/ml, n=213BNP100pg/ml, n=176P=0.0028BNP100pg/ml, n=213BNP100pg/ml, n=176BNP and Arrhythmic PrognosisKITASATO UNIVERSITYRemodeling vs. Reverse RemodelingCardiac Resynchronization Ther

7、apy (CRT) vs. Reverse RemodelingBefore CRTTwo weeks later One year laterEchocardiogram（TMF）after CRTBefore CRTOne year laterReverse Remodeling vs. Gene ExpressionSpraggDD、David DA，Circulation. 2003.Clinical IndicatorCheck Point for CHF ManagementDry+WarmBNP200Reverse RemodelingHospitalizationLethal/

8、DisabilityTherapeutic planFundamental TXAdjunctive TXReinforce TXDefaultLVAD/HTXTotal BililbinCare/HospiceAnti-Remodeling and Reverse RemodelingMancinid & Burkhoff，Circulation, 2005Acute Heart FailureChronic Heart FailurePrimary Endpoint (J-WIND)Ejection Fraction (EF) in Chronic StageKitakazeKitakaz

9、eM et. al M et. al LancetLancet2007; 370: 14832007; 370: 1483Control（n=187n=187）Nicorandil（n=190n=190）p=0.460p=0.460363640404444484800(%)(%)Control（n=199n=199）ANP（n=155n=155）363640404444484800(%)(%)p=0.024p=0.024左左室室駆駆出出率率hANPNicorandil左左室室駆駆出出率率43.2%42.5%44.7%42.5%Six Months BNP & CV EventsCV event

10、Observation（Mo）0.00.10.20.30.40.50.60.70.80.91.0681012141618202224P 0.0001P 380 pg/ml, n=14BNP：190 to 380 pg/ml, n=20BNP： 190 pg/ml, n=49Nishii M et al: JACC 51(24):2329-35, 2008LVEF (%)P=0.000101020304050at dischargeat 6 monthsLVEF (%)P=0.000101020304050at dischargeat 6 monthsLVEF (%)P=0.0001010203

11、04050at dischargeat 6 monthsLVEF (%)P=0.000101020304050at dischargeat 6 monthsLVEF (%)P=0.000101020304050at dischargeat 6 monthsLVEF (%)at dischargeat 6 monthsLVEF (%)P=0.00010102030405001020304050at dischargeat 6 monthsSix Months BNP & Reverse RemodelingLVDd (cm)P=0.00555.566.57at dischargeat 6 mon

12、thsLVDd (cm)P=0.00555.566.57at dischargeat 6 monthsLVDd (cm)P=0.00555.566.57at dischargeat 6 monthsLVEFat dischargeat 6 monthsP=0.005LVDd (cm)55.566.57LVDd (cm)55.566.57at dischargeat 6 monthsLVDd:BNP190Nishii M et al: JACC 51(24):2329-35, 2008-5051015202530The percentage change in LVDs (%)BNP 190pg/mlBNP 190pg/ml(LVDs at post-discharge 6 month LVDs at discharge) / LVDs at discharge x 100P=0.003205-0.51Six Months BNP Reverse RemodelingSummary BNP guided therapy produces a superior and excellent outcome through physicians awareness toward their proper treatment. However