左室射血分数保留的心衰一个被低估的问题课堂PPT

1、123451. 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;

2、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, libby p, eds.

3、 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左心室压力左心室压力左心室容积左心室容积舒张功能不全舒张功能不全高血压高血压 高龄高龄左心室肥厚左心室肥厚向心性重构向心性重构收缩功能不全收缩功能不全心梗、心肌病、心梗、心肌病、容量负荷过重容量负荷过重高血压高血压离心性重构离心性重构调节剂调节剂:血管紧张素血管紧张素ii, 醛固酮醛固酮, 儿茶酚胺儿茶酚胺,细胞因子

4、细胞因子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 engl j med

5、. 2006;355:260-2693. gottdiener js et al. ann intern med. 2002;137:631-639framingham2olmsted1chs3owan4bhatia5373617060597888015702167 2429n=患者患者 (%)n =chf患者总人数55635975584948577150020406080100ef尚正常尚正常ef降低降低181920212223242526hf的症状或体征的症状或体征lvef 50% 且且 左心室舒张末期容积指数左心室舒张末期容积指数(lved vi) 12 mm hg或或左心室舒张末压左心

6、室舒张末压 16 mm hg组织多普勒组织多普勒nt probnp 220 pg/mlbnp 200 pg/mle/e 1515 e/e 8超声血流多普勒超声血流多普勒 :. e/a dt. 肺静脉血流肺静脉血流.左房扩大左房扩大 . 左心室肥厚左心室肥厚.房颤房颤nt probnp 220 pg/mlor bnp 200 pg/mlhfnef组织组织多普勒多普勒e / e 8 from paulus eur heart j. 20072728swedberg et al. eur heart j. 2005:26;1115-1140.29swedberg et al. eur heart j

7、. 2005:26;1115-1140.3031schmieder re et al. j hum hypertens. 2000;14:597-604;schlaich mp et al. clin nep危险比ol. 1998;49:153-159; schmieder re et al. am j med. 1988;84:s136-s139.32-16-14-12-10-8-6-4-20利尿剂利尿剂阻滞剂阻滞剂钙拮抗剂钙拮抗剂aceiarbs-8%-6%-11%-10%-13%左心室重左心室重量下降量下降(%)80个随机对照研究，个随机对照研究，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 (