左室射血分數(shù)保留的心力衰竭

1、123定義為:4n心功能不全51. HFSA, J Card Fail. 2006;12:1;2. Oh JK et al. J Am Coll Card. 2006;47:500-506;67866-10375-8670-847550402555-95787675606865年齡段平均年齡美國 (CHS)芬蘭(Helsinki)英國(Poole)丹麥. (Copen.)西班牙 (Asturias)葡萄牙(EPICA)荷蘭 (Rotter.)瑞典(Vasteras)左心室收縮功能降低的比例HF-PSF的比例55516846715939711. Petrie M, McMurray J. Lan

2、cet. 2001;358:423-434. 2. Hogg K et al. J Am Coll Card. 2004;43:317-327.CHF患病率患病率 (%)01234567891091. Owan TE et al. N Engl J Med. 2006;355:251-259.10111. Hogg K et al. J Am Coll Card. 2004;43:317-327.12Bhatia RS et al. N Engl J Med. 2006;355:260-269.13Givertz MM et al. In: Braunwald E, Zipes DP, Lib

3、by P, eds. Heart Disease, A Textbook of 心血管 Medicine. 7th edition. Philadelphia, Pa: WB Saunders. 2001;534-561.14Sanderson JE. Heart 2007;93:155-158.15左心室壓力左心室壓力左心室容積左心室容積舒張功能不全舒張功能不全高血壓高血壓 高齡高齡左心室肥厚左心室肥厚向心性重構向心性重構收縮功能不全收縮功能不全心梗、心肌病、心梗、心肌病、容量負荷過重容量負荷過重高血壓高血壓離心性重構離心性重構調節(jié)劑調節(jié)劑:血管緊張素血管緊張素II, 醛固酮醛固酮, 兒茶酚

4、胺兒茶酚胺,細胞因子細胞因子Adapted from Zile MR, Brutsaert DL. Circulation. 2002;105;1387-1393.16Dzau V. Am Heart J. 1991;121:1244-1263. 171. Senni M et al. Circulation. 1998;98:2282-2289. 4. Owan TE et al. N Engl J Med. 2006;355:251-2592. Vasan RS et al. J Am Coll Card. 1999;33:1948-1955. 5. Bhatia RS et al. N

5、Engl J Med. 2006;355:260-2693. Gottdiener JS et al. Ann Intern Med. 2002;137:631-639Framingham2Olmsted1CHS3Owan4Bhatia5373617060597888015702167 2429n=患者患者 (%)n =CHF患者總人數(shù)55635975584948577150020406080100EF尚正常尚正常EF降低降低181920212223242526HF的癥狀或體征的癥狀或體征LVEF 50% 且且 左心室舒張末期容積指數(shù)左心室舒張末期容積指數(shù)(LVED VI) 12 mm Hg或

6、或左心室舒張末壓左心室舒張末壓 16 mm Hg組織多普勒組織多普勒NT proBNP 220 pg/mlBNP 200 pg/mlE/E 1515 E/E 8超聲血流多普勒超聲血流多普勒 :. E/A DT. 肺靜脈血流肺靜脈血流.左房擴大左房擴大 . 左心室肥厚左心室肥厚.房顫房顫NT proBNP 220 pg/mlor BNP 200 pg/mlHFNEF組織組織多普勒多普勒E / E 8 From Paulus Eur Heart J. 20072728Swedberg et al. Eur Heart J. 2005:26;1115-1140.29Swedberg et al. E

7、ur Heart J. 2005:26;1115-1140.30311. Schmieder RE et al. J Hum Hypertens. 2000;14:597-604;2. Schlaich MP et al. Clin Nep危險比ol. 1998;49:153-159; 3. Schmieder RE et al. Am J Med. 1988;84:S136-S139.32-16-14-12-10-8-6-4-20利尿劑利尿劑阻滯劑阻滯劑鈣拮抗劑鈣拮抗劑ACEIARBs-8%-6%-11%-10%-13%左心室重左心室重量下降量下降(%)80個隨機對照研究，個隨機對照研究，4,113例患者例患者Klingbeil AU et al. Am J Med. 2003;115:41-46.33CHARM34Year 1: HR 0.69 (0.47,1.01), p=0.055Year 2: HR 0.92