版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
Advancementofdiagnosisandtherapyincardiomyopathies
心肌病诊治进展
LIAOYu-HuaInstituteofCardiology,UnionHospital,TongjiMedicalCollegeofHuazhongUniversityofScienceandTechnology,Wuhan,China精选课件ContemporaryDefinitionsandClassificationoftheCardiomyopathies
(2006AHA)
Cardiomyopathiesareaheterogeneousgroupofdiseasesofthemyocardiumassociatedwithmechanicaland/orelectricaldysfunctionthatusually(butnotinvariably)exhibitinappropriateventricularhypertrophyordilatationandareduetoavarietyofcausesthatfrequentlyare
genetic.Cardiomyopathieseitherareconfinedtotheheartorarepartofgeneralizedsystemicdisorders,oftenleadingtocardiovasculardeathorprogressiveheartfailure–relateddisability.MaronBJ,etal.Circulation,2006,113:1807-1816精选课件ClassificationCardiomyopathiescanbemosteffectivelyclassifiedasprimary:
genetic,mixed(geneticandnongenetic),acquired;and
secondaryPrimarycardiomyopathiesarethosesolelyorpredominantlyconfinedtoheartmuscleandarerelativelyfewinnumberSecondary
cardiomyopathiesshowpathologicalmyocardialinvolvementaspartofalargenumberandvarietyofgeneralizedsystemic(multiorgan)disordersMaronBJ,etal.Circulation,2006,113:1807-1816精选课件MaronBJ,etal.Circulation,2006,113:1807-1816精选课件DilatedCardiomyopathyDilatedformsofcardiomyopathyarecharacterizedbyventricularchamberenlargementandsystolicdysfunctionwithnormalLVwallthickness;usuallydiagnosisismadewith2-dimensionalechocardiographyDCMisacommonandlargelyirreversibleformofheartmusclediseasewithanestimated
prevalenceof1:2500;itisthethirdmostcommoncauseofheartfailureandthemostfrequentcauseofhearttransplantationMaronBJ,etal.Circulation,2006,113:1807-1816精选课件DCMphenotypewithgeneticoccurrencAbout20%to35%ofDCMcaseshavebeenreportedasfamilial,althoughwithincompleteandage-dependentpenetrance,andlinkedtoadiversegroupof20lociandgenes.DCMisalsocausedbyanumberofmutationsinothergenesencodingcytoskeletal/sarcolemmal,nuclearenvelope,sarcomere,andtranscriptionalcoactivatorproteins.ThemostcommonoftheseprobablyisthelaminA/Cgene,alsoassociatedwithconductionsystemdisease,whichencodesanuclearenvelopeintermediatefilamentprotein.MaronBJ,etal.Circulation,2006,113:1807-1816精选课件DCMphenotypewithsporadicoccurrenceInfectiousagents,particularlyviruses(coxsackievirus,adenovirus,parvovirus,HIV);bacterial;fungalrickettsial;myobacterial;andparasiticOthercausesincludetoxins;chronicexcessiveconsumptionofalcohol;chemotherapeuticagents;metalsandothercompounds;autoimmuneandsystemicdisorders;pheochromocytoma;neuromusculardisorderssuchasDuchenne/BeckerandEmery-Dreifussmusculardystrophies;andmitochondrial,metabolic,endocrine,andnutritionaldisordersMaronBJ,etal.Circulation,2006,113:1807-1816精选课件Criteria
①leftventricularend-diastolicdimension(LVEDd)>2.7cm/m2②leftventricularejectionfraction(LVEF)<45%and/orfactionalshortening
<25%
Exclusion:①hypertension,②CHD,③long-termoverdosedrinkingalcohol,④persistencesupraventriculararrhythmia,⑤systemicdisease,⑥pericardialdisease,⑦congenitalheartdisease,⑧pneumocardialdisease
DiagnosticcriteriaofidiopathicdilatedcardiomyopathyManolioTA,etal.AmJCardiol,1992,69:1459–66精选课件①diagnosticcriteriaofdilatedcardiomyopathy②Thediagnosisoffamilialdilatedcardiomyopathyis
made:1.inthepresenceoftwoormoreaffectedindividualsinasinglefamily2.orinthepresenceofafirst-degreerelativeofadilatedcardiomyopathypatient,withwelldocumentedunexplainedsuddendeathat<35yearsofageDiagnosis
offamilialdilatedcardiomyopathyMestroniL,etal.
EuroHeartJ,1999,20:93–102精选课件①diagnosticcriteriaofdilatedcardiomyopathy
②immunologicmarkers—anti-heartantibodiesaremainmarkers1including:anti-ANTAb、anti-ß1-receptorAb、anti-MHCAb、anti-M2-receptorAb
Secondarymarkersincluding:
persistentviralinfectionTh2cellpredominancecytokinesgenetypeofhumamleucocyteantigenDiagnosis
ofimmune
dilatedcardiomyopathy
1苑海涛,廖玉华等.临床心血管病杂志,2000,16:313-315精选课件AnalysisofautoantibodyindilatedcardiomyopathyANT31*(64.6%)4(8.3%)64.6%91.7%β126*(54.2%)4(8.3%)54.2%91.7%M220*(41.7%)3(6.3%)41.7%93.7%MHC23*(47.9%)2(4.2%)47.9%95.8%
positiveofautoantibodyinDCM
AHAinDCMPeptides
DCMgroup
(n=48)
HDgroup
(n=48)
sensitivity
specificity
n(%)n(%) ComparedwithHDgroup*p<0.005苑海涛,廖玉华.临床心血管病杂志,2000,16:313精选课件ImmunopathogenesisinDCMVoltage-gatingCa-channelsCa-overloadCelldamageCardiacdilationReceptor-gatingCa-channelsVirusinfectionandautoimmunityresponseDCMAnti-ANT-AbAnti-ß1-RAb精选课件TreatmentofDCM1、Conventionaltreatmentofheartfailure2、Preventembolism3、PreventSCD4、Improvecardiacmetabolism5、Cardiacresynchronizationtherapy6、Cardiactransplantation7、ImmunologictherapyinDCM精选课件1.β-receptorblockerToinhibittheanti-β1-Abmediatedmyocardiualdamage,especiallyinearlystageEspeciallysuitforthepatientswithtachycardiaorventriculararrhythmias,orwithanti-β1-AbpatientsDose:metroprolol6.25mgBidto12.5~100mgBid,slowlytitrateBlockedautoantibodiesresponse(1)精选课件
MDCtrial
Patients345,MGn=177andPGn=16816-75yearsofage
Metoprolol10mg/day→100~150mg/day
therapyofHF:digitalis、diuretics、ACEI
Followingup18months
MetoprololisindicatedtoimprovequanlityoflifeinheartfailurewithDCMβ-receptorblocker
clinicaltrialinDCMWaagsteinF,etal.Lancet,1993,342:1441-46
精选课件2.DiltiazemFrequeceofAnti-ANTantibodyispositiveabout60%-95%Mechanism:Anti-ANTantibodyincreasedCacurrentofmyocardialcell.DiltiazemcouldinhibittheantibodymediatedmyocardialdamageandprotectmyocardiumDiltiazemmightbeusedinearlystageofDCMDosage:diltiazem30mgtid
Blockedautoantibodiesresponse
(2)精选课件CalciumantagonistclinicaltrialinDCMDiDitrialPatients186,DGn=92andPGn=9418~70yearsofagetheadjuncttherapyofdiltiazem60~90mgtidonstandardtreatmentDiDitrialisshowedtoimprovecardiacfunction,exercisecapacityandsubjectivestatusinDCMFigullaHR.Circulation,1996,94:346-352.精选课件CalciumantagonistclinicaltrialinDCMISDDCtrialToevaluateeffectsofdiltiazemonheartfunctionandprognosisinDCMMultiplecentre,random,placebo-control
Followingup6~12monthsPatients221,PGn=107andDGn=114,46±12yearsofageDiltiazem60~90mg/dayorVitB160mg/day
TherapyofHF:digoxine,diuretics,ACEILiaoYH.IntJCardiol,1998,64:25-30.精选课件ISDDCtrial
PrognosisanalysisinDCM
PlaceboDiltiazemn=107n=114Outpatienttreatment63(58.9)102(89.5)***
Repeatedhospitalization44(41.1)12(10.5)***Death12(11.2)4(3.5)**Comparedwithplacebogroup**p<0.05,***p<0.01LiaoYH.IntJCardiol,1998,64:25-30.精选课件
BeforeAfterLVEDd>70mm(n=28)
LVEDd77.61±5.3874.50±8.92*
EF27.68±11.6933.71±12.64*
LVEDd<70mm(n=86)
LVEDd61.34±4.9156.88±5.32**
EF38.76±8.7546.07±7.88**
Comparedwithbeforetreatment,*p>0.05,**p<0.01
ISDDCtrialSubgroupanalysisofheartfunctionLiaoYH.IntJCardiol,1998,64:25-30.精选课件HeartimageafterdiltiazemtreatedDCM2000-8-11CTR0.451999-1-18CTR0.51998-9-17CTR0.6精选课件ISDDCtrialconclusionLiaoYH.IntJCardiol,1998,64:25-30.diltiazemissafeandeffectiveinthetreatmentofDCMtheactionmechanismmightbeinterventioninantibody-mediatedmyocardialdamageandprotectionofmyocardiumdiltiazemismoresuitablefortreatmentof
theearlystageinDCM
精选课件PathogenesisandtreatmentinDCMß1-blocksDiltiazemVoltage-gatingCa-channelsCa-overloadCelldamageCardiacdilation
Receptor-gatingCa-channelsVirusinfectionandautoimmunityresponseAnti-ANT-AbAnti-ß1-RAbTherapyofHFDCMHFnoHFSevereHFLiaoYH.2001精选课件ImmunoadsorptionofautoantibodiesAnti-β1-adrenoceptorantibodyremovedbyimmunoadsorptioninpatientswithDCM,meanwhiletreatmentofheartfailureFollow-uponeyear,LVEFincreasing15%(22.3±3.3%to37.9±7.9%)
andLVEDddecreasing14.5%(74.5±7.1to63.7±6.0mm)inDCMgroup;LVEF(23.8±3.0to25.2±5.9%)noimprovement
andLVEDddecreased3.8%incontrolgroupTheclinicaltrialconfirmedthatremovingtheautoantibodiesmightimproveheartfunctioninDCMMüllerJ,etal.Circulation,2000,101:385-39SchimkeI,etal.JClinApher,2005,20:137-42精选课件ImmunomodulatingtherapyImmunomodulatingtherapywithintravenousimmunoglobulin2g/kginpatientswithchronicheartfailurewithin6monthsrecentlydiagnosedDCMAftertreated6monthsand12months,LVEFincreasing(0.25±0.08to0.41±0.17/6monthand0.42±0.14/12month)inpatientswithDCMThefindingsuggestsimmunoglobulinmight
regulatethebalanceofinflammatoryfactorand
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 定音鼓市场发展预测和趋势分析
- 办公用胶产业深度调研及未来发展现状趋势
- 人教版英语八年级上册单元基础过关Units 4-5练习
- 工业用竹篮产业规划专项研究报告
- 壁炉炉钳市场需求与消费特点分析
- 家用切肉机产业规划专项研究报告
- 巴拉克拉瓦头套产业运行及前景预测报告
- 具有空气净化功能的防尘口罩市场需求与消费特点分析
- 外科用羊肠线产业深度调研及未来发展现状趋势
- 心脏内导管产业运行及前景预测报告
- 临床医学职业生涯规划
- 中国风书法练字字帖
- 《煤矿安全生产方面的新政策、规定和要求》培训课件2024
- (2024年)《工伤保险培训》ppt课件完整版
- GB/T 43802-2024绿色产品评价物流周转箱
- GB/T 43824-2024村镇供水工程技术规范
- 扣好人生第一粒扣子争做新时代好少年班会课件
- 企业人才测评在线测评题库及答案
- 2024泸州老窖集团校园招聘笔试参考题库附带答案详解
- 《苹果公司发展史》课件
- 学生牛奶、糕点配送服务承诺及售后服务
评论
0/150
提交评论