如何避免慢性力衰竭恶化

1、* plasma bnp level is titrated by ria using shionoria (shionogi, osaka)after discharge with/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, t

2、here were significantly lower cardiac events, readmission, in bnp guided tx in comparison with 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 2

3、004bnp guided tx cancelled out prognostic contribution by af in chf managementaltered prognosis 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/mlremodeling vs. reverse rem

4、odelingremodeling vs. reverse remodelingcardiac resynchronization therapy cardiac resynchronization therapy (crt) vs. reverse remodeling(crt) vs. reverse remodelingbefore crtbefore crttwo weeks later two weeks later one year laterone year laterechocardiogramechocardiogram（tmftmf）after crtafter crtbe

5、fore crtbefore crtone year laterone year laterreverse remodeling and reverse remodeling and -blocker-blocker（carvedilolcarvedilol）0 05 510101515placeboplacebo6.25mg bid6.25mg bid 12.5mg bid12.5mg bid25mg bid25mg bidwohlschlaeger j, babawohlschlaeger j, babaah et al, cardiovas resah et al, cardiovas

6、res、20052005ejection fraction (ef) in chronic stageejection fraction (ef) in chronic stagekitakazekitakazekitakazekitakaze m et. al m et. al m et. al m et. al lancetlancetlancetlancet2007; 370: 14832007; 370: 14832007; 370: 14832007; 370: 1483controlcontrol（n=187n=187n=187n=187 ）nicorandilnicorandil

7、（n=190n=190n=190n=190 ）p=0.460p=0.460p=0.460p=0.460363636364040404044444444484848480 0 0 0(%)(%)(%)(%)controlcontrol（n=199n=199n=199n=199 ）（n=155n=155n=155n=155 ）363636364040404044444444484848480 0 0 0(%)(%)(%)(%)p=0.024p=0.024p=0.024p=0.024左左左左室室室室駆駆駆駆出出出出率率率率hanphanpnicorandilnicorandil左左左左室室室室駆駆駆

8、駆出出出出率率率率the preami investigators, arch intern med 2006the preami investigators, arch intern med 2006anti-remodeling & perindoprilanti-remodeling & perindoprilincv eventobservation（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： 1

9、90 pg/ml, n=49lvef (%)at dischargeat 6 monthslvef (%)p=0.00010102030405001020304050at dischargeat 6 monthslvefat dischargeat 6 monthsp=0.005lvdd (cm)55.566.57lvdd (cm)55.566.57at dischargeat 6 monthslvdd:bnp190summary 1. bnp guided therapy produces a superior and excellent outcome through physicians awareness toward their proper treatment. 2. however, the bnp measurement is not almighty diagnostic tool leadi