HFpEF诊断和治疗新进展
合集下载
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
The online version of this article, along with updated information and services, is located on the World Wide Web at:
http://circ.ahajournals.org/content/early/2018/05/22/CIRCULATIONAHA.118.034646
2016 ESC Heart Failure Guideline
HFpEF和收缩性心衰对治疗的反应
Circulation. 2011;123:2006-2014.
TOPCAT：螺内酯对HFpEF终点的作用
Time to the First Confirmed Primary-Outcome Event
E/e’>8
HFpEF
ESC 2013 algorithm for HFpEF diagnosis
A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure with Preserved Ejection Fraction
N Engl J Med 2015; 373:2314-2324
Change in Activity Levels with Increasing Doses of Isosorbide Mononitrate or Placebo.
N Engl J Med 2015; 373:2314-2324
Time to Death fr百度文库m Any Cause
N Engl J Med 2014;370:1383-92.
• 药物的原因？ • HFpEF诊断的依据？
RLAX: Effect of Phosphodiesterase-5 Inhibition on Exercise Capacity and Clinical Status in HFpEF
EF>50% And
LVEDVI<97 ml/m2
E/e’>15
15>E/e’>8
NTproBNP>200 pg/ml
NTproBNP>200 pg/ml
E/A<0.5 Or LAVI>40 ml/m2 Or LVMI>122 g/m2(F),>149 g/m2
(M) Or Atrial fibrillation
Hg) or with exercise (≥25 mm Hg), • NT-proBNP>400 or BNP>200, • Doppler echocardiographic evidence of diastolic
dysfunction.
Primary and Secondary End Points for Activity Levels
Change in peak VO2 from baseline to 24 weeks
JAMA. 2013;309(12):1268-1277.
• ≥50yrs + stable medical therapy: • LVEF≥50% + objective evidence of HF, • X-ray evidence of pulmonary congestion, • LVEDP at rest (≥15 mm Hg) or PCWP at rest (≥20 mm
IN-DIE Study population
• NYHA class II-IV HF symptoms + EF ≥ 50% • Objective evidence of HF (at least one)
HF hospitalization Elevated NT-proBNP or BNP Elevated rest or exercise PAWP at RHC Echo Doppler DD + Loop diuretic
HFpEF诊断和治疗新进展
2018中国心衰诊断与治疗指南
— 采用心衰新的分类及诊断标准
心衰（HFmrEF）被单独提出，此亚组的临床特征、治疗方式和预后尚不清楚，单独 列出此组有利于促进对这部分心衰患者特点、病理生理机制和治疗的研究。
诊断
ESC 2007 algorithm for HFpEF diagnosis
Data Supplement (unedited) at:
http://circ.ahajournals.org/content/suppl/2018/05/22/CIRCULATIONAHA.118.034646.DC1
治疗
• No treatment has yet been shown, convincingly, to reduce mor- bidity or mortality in patients with HFpEF or HFmrEF. However, since these patients are often elderly and highly symptomatic, and often have a poor quality of life, an important aim of therapy may be to alleviate symptoms and improve well-being.
Yogesh N. V. Reddy, Rickey E. Carter, Masaru Obokata, Margaret M. Redfield and Barry A. Borlaug
Circulation. published online May 23, 2018;
Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2018 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
http://circ.ahajournals.org/content/early/2018/05/22/CIRCULATIONAHA.118.034646
2016 ESC Heart Failure Guideline
HFpEF和收缩性心衰对治疗的反应
Circulation. 2011;123:2006-2014.
TOPCAT：螺内酯对HFpEF终点的作用
Time to the First Confirmed Primary-Outcome Event
E/e’>8
HFpEF
ESC 2013 algorithm for HFpEF diagnosis
A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure with Preserved Ejection Fraction
N Engl J Med 2015; 373:2314-2324
Change in Activity Levels with Increasing Doses of Isosorbide Mononitrate or Placebo.
N Engl J Med 2015; 373:2314-2324
Time to Death fr百度文库m Any Cause
N Engl J Med 2014;370:1383-92.
• 药物的原因？ • HFpEF诊断的依据？
RLAX: Effect of Phosphodiesterase-5 Inhibition on Exercise Capacity and Clinical Status in HFpEF
EF>50% And
LVEDVI<97 ml/m2
E/e’>15
15>E/e’>8
NTproBNP>200 pg/ml
NTproBNP>200 pg/ml
E/A<0.5 Or LAVI>40 ml/m2 Or LVMI>122 g/m2(F),>149 g/m2
(M) Or Atrial fibrillation
Hg) or with exercise (≥25 mm Hg), • NT-proBNP>400 or BNP>200, • Doppler echocardiographic evidence of diastolic
dysfunction.
Primary and Secondary End Points for Activity Levels
Change in peak VO2 from baseline to 24 weeks
JAMA. 2013;309(12):1268-1277.
• ≥50yrs + stable medical therapy: • LVEF≥50% + objective evidence of HF, • X-ray evidence of pulmonary congestion, • LVEDP at rest (≥15 mm Hg) or PCWP at rest (≥20 mm
IN-DIE Study population
• NYHA class II-IV HF symptoms + EF ≥ 50% • Objective evidence of HF (at least one)
HF hospitalization Elevated NT-proBNP or BNP Elevated rest or exercise PAWP at RHC Echo Doppler DD + Loop diuretic
HFpEF诊断和治疗新进展
2018中国心衰诊断与治疗指南
— 采用心衰新的分类及诊断标准
心衰（HFmrEF）被单独提出，此亚组的临床特征、治疗方式和预后尚不清楚，单独 列出此组有利于促进对这部分心衰患者特点、病理生理机制和治疗的研究。
诊断
ESC 2007 algorithm for HFpEF diagnosis
Data Supplement (unedited) at:
http://circ.ahajournals.org/content/suppl/2018/05/22/CIRCULATIONAHA.118.034646.DC1
治疗
• No treatment has yet been shown, convincingly, to reduce mor- bidity or mortality in patients with HFpEF or HFmrEF. However, since these patients are often elderly and highly symptomatic, and often have a poor quality of life, an important aim of therapy may be to alleviate symptoms and improve well-being.
Yogesh N. V. Reddy, Rickey E. Carter, Masaru Obokata, Margaret M. Redfield and Barry A. Borlaug
Circulation. published online May 23, 2018;
Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2018 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539