充血性心力衰竭PPT课件

Days
Days
7
1Packer M et al. N Engl J Med. 1996;334:1349–1355. 2MERIT-HF Study Group. Lancet. 1999;253:2001–2007. 3CIBIS-II Investigators.
Lancet. 1999;353:9–13. 4Packer M et al. N Engl J Med. 2001;344:1651–1658.
Morbidity and Mortality
2020年10月2日
4
Adrenergic Pathway in Heart Failure Progression
CNS sympathetic outflow
Vascular sympathetic activity
Cardiac sympathetic activity
Disease progression
5
Beta-blocker Therapy in Heart Failure
Potential Beneficial Effects
Protection from Catecholamine
Toxicity
Renin Angiotensin
System
Reversal of Remodeling
Probability of Event-free Survival
US Carvedilol Trials1
1.0 Carvedilol (n=696)
MERIT-HF2
20
Placebo (n=2001)
0.9
Placebo (n=398) 65%
0.8
P<.001
15
34%
P=.0062 (adjusted)
2020年10月2日
2
ACC/AHA Proposed Stages of HF
STAGE A High risk for developing HF STAGE B Asymptomatic LV dysfunction STAGE C Past or current symptoms of HF STAGE D End-stage HF
asymptomatic and symptomatic stages • HF morbidity and mortality can be reduced
by stage specific treatments
Hunt, et al. J Am Coll Cardiol. 2001; 38:2101-2113.
Renal sympathetic activity
b1 b2 1
1
b1 1
Myocyte hypertrophy Myocyte injury
Increased arrhythmias
Vasoconstriction
Activation of RAS
Sodium retention
2020年10月2日
8
Packer M et al. N Engl J Med. 2001;344:1651–1658.
COPERNICUS: Number of Hospitalizations
For any reason
900
Congestive Heart Failure Collaborative, October 14, 2004
Preventing Readmissions
Kenneth A. LaBresh, MD, FAHA, FACC V.P., Medical Affairs and Quality Improvement, Maபைடு நூலகம்sPRO
Up-regulation of b-adrenergic
Receptors
2020年10月2日
Ancillary Factors
6
Major Placebo Controlled Trials of
b-Blockade in Heart Failure
Cumulative Mortality (%)
COPERNICUS: All-Cause
Mortality
All patients
100
% Survival
90
Carvedilol
(n=1156)
80
Placebo
70
(n=1133)
Risk
Reduction
60
35%
P=.00013
50
0 4 8 12 16 20 24 28
Months
2020年10月2日
Hunt, et al. J Am Coll Cardiol. 2001; 38:2101-2113.
2020年10月2日
3
Neurohormonal Activation in
Heart Failure
Angiotensin II
Norepinephrine
Hypertrophy, apoptosis, ischemia, arrhythmias, remodeling, fibrosis
10
Metoprolol CR/XL
5
(n=1990)
0.7 0.0
0
1.0
100 200 300 400 Days
CIBIS-II3
Bisoprolol (n=1327)
0 0
100 90
100 200 300 400 500 600 Days
COPERNICUS4
Carvedilol (n=1156)
Survival (% of Patients)
Survival
0.8 34%
P<.0001
0.6
Placebo (n=1320)
80 35%
70 P=.00013
60
Placebo (n=1133)
0.0
0
0
200
400
600
800
0 100 200 300 400 500 600
2020年10月2日
Clinical Associate Professor, Brown University
2020年10月2日
1
ACC/AHA Guidelines for Evaluation and Management of Chronic Heart Failure 2001
• HF can be prevented • HF has established risk factors • HF is a progressive condition with