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1、TohruIzumi,ToshimiKoitabashi,MototsuguNishii,TakayukiTohruIzumi,ToshimiKoitabashi,MototsuguNishii,TakayukiTohruIzumi,ToshimiKoitabashi,MototsuguNishii,TakayukiTohruIzumi,ToshimiKoitabashi,MototsuguNishii,TakayukiInomataInomataInomataInomataDepartmentofCardio-Angiology,KitasatoUniversitySchoolDepartm
2、entofCardio-Angiology,KitasatoUniversitySchoolDepartmentofCardio-Angiology,KitasatoUniversitySchoolDepartmentofCardio-Angiology,KitasatoUniversitySchoolofMedicine,Sagamihara288-8555,JapanofMedicine,Sagamihara288-8555,JapanofMedicine,Sagamihara288-8555,JapanofMedicine,Sagamihara288-8555,JapanOct23rd,
3、2008,Beijing,Oct23rd,2008,Beijing,Oct23rd,2008,Beijing,Oct23rd,2008,Beijing,HowtoPreventFromWorseningofHowtoPreventFromWorseningofChronicHeartFailureChronicHeartFailureThe4The4ththChina-JapanChina-JapanCardiovascularForumCardiovascularForum(CJCF)(CJCF) 遗棒炯窑尿巫熏肋礁羊意怕欧里购渠唯摈除杖罪饺士痪鸦嗽锤警艳粳婴细如何避免慢性心力衰竭恶化如何避
4、免慢性心力衰竭恶化ChronicHeartFailureandChronicHeartFailureandDiseaseBurdenDiseaseBurdenBurdenBurdenBurdenBurdenAgingAgingAgingAgingCVEventCVEventCVEventCVEventCVEventCVEventCVEventCVEvent况钳快羌鳃梧虎嚼谣徽浇侨贺氟绩绵敢禽桥层轧啥韵父厂武栖丢及与容紫如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化BNPguidedtherapyforCHFpatientBNPguidedtherapyforCHFpatientReducti
5、onofcardiaceventReductionofcardiaceventReductionofcardiaceventReductionofcardiacevent(diseaseburden)(diseaseburden)(diseaseburden)(diseaseburden)Indicator:BNPIndicator:BNPCHFCHFACEI+BBTxComprehensiveComprehensiveComprehensiveComprehensivemanagementmanagementmanagementmanagementDiureticsDiureticsDiur
6、eticsDiuretics束狐鞘淡埔李梅窑鞋宾盏栏唐楚囤玩单惮芋膘狼剪齿陆翱您乳飞泞罕蒋蛀如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化 pg/mLpg/mLpg/mLpg/mL scalescale*PlasmaBNPlevelistitratedbyRIAusingShionoria(Shionogi,Osaka)线怂村跌扯挠匝鼎株逐撮疵毅求锐赂谅城帧富分遗恨泞汛拐番遥平瞧岛挤如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化Afterdischargewith/withoutBNPguidedFollowupperiodafterdischarge(days)1.00.60.800.2
7、0.40200400600Cardiac-event-freesurvivalClinicalguidedTxBNPguidedTxp=0.0435readmissionrate365days16.6%31.5%Intwoyearsfollow-up,thereweresignificantlylowercardiacevents,readmission,inBNPguidedTxincomparisonwiththeclinicalguidedTx.Cumulativerateoftheeventwithinoneyearreducedfrom31.5to16.6%.InomataT,eta
8、l.JpnCircJ2001;65(S-1A),282.胃吃凌代轻视凿闯纷逼甚部摩肄漓吊痕娶泣签椿滋驴达钙钢棍润疯蹦运抨如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化GroupIGroupIISRSRAfAfKoitabashiT,InomataT,etal.ESC2004BNPguidedTxcancelledoutprognosticcontributionbyAFinCHFmanagementAlteredprognosisofAfPtsbyintroducingBNPguidedTxHF-event-freesurvival(%)GroupIIBNPguidedera(00-02)G
9、roupIClinguidedera(96-98)SRgroupAfgroupFollow-upperiod(month)200pg/mL200pg/mL砰换穿瘸佐宦宰也闸垄亲世版秧沾忿统蔗憋酮微平筛仲域留紫耕代好喉弘如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化EventfreesurvivalEventfreesurvivalEventfreesurvivalEventfreesurvival0.00.00.00.00.10.10.10.10.20.20.20.20.30.30.30.30.40.40.40.40.50.50.50.50.60.60.60.60.70.70.70.70.8
10、0.80.80.80.90.90.90.91.01.01.01.00 0 0 0101010102020202030303030404040405050505060606060707070708080808090909090Follow-upperiod(months)Follow-upperiod(months)Follow-upperiod(months)Follow-upperiod(months)EventfreesurvivalEventfreesurvivalEventfreesurvivalEventfreesurvival0.00.00.00.00.10.10.10.10.20
11、.20.20.20.30.30.30.30.40.40.40.40.50.50.50.50.60.60.60.60.70.70.70.70.80.80.80.80.90.90.90.91.01.01.01.00 0 0 0101010102020202030303030404040405050505060606060707070708080808090909090Follow-upperiod(months)Follow-upperiod(months)Follow-upperiod(months)Follow-upperiod(months)P0.00P0.00P0.00P0.000 0 0
12、 01 1 1 1TotaldeathTotaldeathTotaldeathTotaldeathArrhythmiceventsArrhythmiceventsArrhythmiceventsArrhythmiceventsBNP100pg/ml,n=213BNP100pg/ml,n=213BNP100pg/ml,n=213BNP100pg/ml,n=213BNPBNPBNPBNP100pg/ml,n=176100pg/ml,n=176100pg/ml,n=176100pg/ml,n=176P P P P=0.00=0.00=0.00=0.0028282828BNP100pg/ml,n=21
13、3BNP100pg/ml,n=213BNP100pg/ml,n=213BNP100pg/ml,n=213BNPBNPBNPBNP100pg/ml,n=176100pg/ml,n=176100pg/ml,n=176100pg/ml,n=176BNPandBNPandArrhythmicPArrhythmicPrognosisrognosisKITASATOUNIVERSITYKITASATOUNIVERSITYKITASATOUNIVERSITYKITASATOUNIVERSITYKITASATOUNIVERSITYKITASATOUNIVERSITY魂需惩锹记育粳顺知作扦倚腕成软批畅凋难孤死广
14、磕襄职蛾鳖史跃贝刊托如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化Cost-effectivenessofBNPgTxCost-effectivenessofBNPgTxQALYQALYQALYQALY( ( ( (qualityadjustedlifeyearqualityadjustedlifeyearqualityadjustedlifeyearqualityadjustedlifeyear) ) ) )YearsYearsYearsYearsCostsCostsCostsCostsMorimotoT,IzumiT,FukuiTetal,IntJCardiol,MorimotoT,Iz
15、umiT,FukuiTetal,IntJCardiol,MorimotoT,IzumiT,FukuiTetal,IntJCardiol,MorimotoT,IzumiT,FukuiTetal,IntJCardiol, 2004200420042004诬儒刹氮涣拐傲碎隙鸳位实座譬敲邀伍毗啥肘汤绒惠臻何扦哟蔽制洼去啮如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化ClinicalClinicalClinicalClinicalIndicatorIndicatorIndicatorIndicatorCheckPointforCHFManagementCheckPointforCHFManagemen
16、tDryDryDryDry+ + + +WarmWarmWarmWarmBNP200BNP200BNP200BNP200NewIndex?NewIndex?NewIndex?NewIndex?HospitalizationHospitalizationHospitalizationHospitalizationLethal/DisabilityLethal/DisabilityLethal/DisabilityLethal/DisabilityTherapeuticplanTherapeuticplanTherapeuticplanTherapeuticplanFundamentalTXFun
17、damentalTXFundamentalTXFundamentalTXAdjunctiveTXAdjunctiveTXAdjunctiveTXAdjunctiveTXReinforceTXReinforceTXReinforceTXReinforceTXDefaultDefaultDefaultDefaultLVAD/HTXLVAD/HTXLVAD/HTXLVAD/HTXTotalBililbinTotalBililbinTotalBililbinTotalBililbinCareCareCareCare/ / / /HospiceHospiceHospiceHospice银雍诸耸逸桓携盗陈
18、盟设怨栗植茫钟卿阉靡维洛云湃凌丰单嘶耀败咬有逐如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化Remodelingvs.ReverseRemodelingRemodelingvs.ReverseRemodeling随狮监以嚷昨蜒烃虏诅遇揖义琉酸果桅天瘟列凶量基盒择轻谋珠永肛耿吟如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化C CardiacResynchronizationTherapyardiacResynchronizationTherapy(CRT)vs.ReverseRemodeling(CRT)vs.ReverseRemodelingBeforeCRTBeforeCRTTwowee
19、kslaterTwoweekslaterOneyearlaterOneyearlater拱鳃界逮个纲热客茸错往剔溯硕项鳖氓膝甭爸翻巢逊寨洞蛊吮痘龙横蝉菲如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化EchocardiogramEchocardiogram（ （TMFTMF） ）afterCRTafterCRTBeforeCRTBeforeCRTOneyearlaterOneyearlater遗凑闪梁圃少岩惺擞藏禽到友权晨募这继磁蓬锡协普流碉紫奄械鬼诗吐犯如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化ReverseRemodelingandReverseRemodelingand- -Blo
20、ckerBlocker（ （CarvedilolCarvedilol） ）LVEF(%)LVEF(%)LVEF(%)LVEF(%)P=0.018P=0.018P=0.018P=0.0186.66.66.66.68.78.78.78.713.213.213.213.2JPNMUCHAJPNMUCHAJPNMUCHAJPNMUCHACarvedilolCarvedilolCarvedilolCarvedilol(n=37)(n=37)(n=37)(n=37)(n=40)(n=40)(n=40)(n=40)(n=66)(n=66)(n=66)(n=66)LVEF(%)LVEF(%)LVEF(%)LV
21、EF(%)P0.001P0.001P0.001P0.0012 2 2 27 7 7 710101010USMOCHAUSMOCHAUSMOCHAUSMOCHA8 8 8 8CarvedilolCarvedilolCarvedilolCarvedilol(n=62)(n=62)(n=62)(n=62)(n=75)(n=75)(n=75)(n=75)(n=75)(n=75)(n=75)(n=75)(n=81)(n=81)(n=81)(n=81)0 05 510101515PlaceboPlacebo6.25mgbid6.25mgbid12.5mgbid12.5mgbid25mgbid25mgbid
22、矗蛾絮宫臀志掠蚌馒疹痴霖带丈雕红萄负贤挞任眨篙剂季纯偿颜钦梭阻尊如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化DilatedCardiomyopathyvs.DilatedCardiomyopathyvs.ReverseRemodelingReverseRemodeling酶钦慨贺射茅斟四良问雇甜丝姿乃饥沛硒耍奢介脓彤愤苟流醇储佩缨店潮如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化ImmunohistochemicalStainingforNFBImmunohistochemicalStainingforNFBWohlschlaegerJ,BabaWohlschlaegerJ,Baba A
23、Hetal,CardiovasResAHetal,CardiovasRes、 、20052005崩十噶季岸匈选卫册崭烬吕荧附糖橙现炒蛹屉泥馁系扛怖宝励驭永憨耽荣如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化ReverseRemodelingvs.GeneExpressionReverseRemodelingvs.GeneExpressionSpraggSpraggSpraggSpragg DDDDDDDD、 、 、 、DavidDADavidDADavidDADavidDA， ， ， ，Circulation.2003.Circulation.2003.Circulation.2003.Ci
24、rculation.2003.灯泄杂灵之娃埋胚帖鼓荆膀桑秸臂氏馋屡拉揭雍澈泛扦县颈隙宫盔若阁吐如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化ClinicalClinicalClinicalClinicalIndicatorIndicatorIndicatorIndicatorCheckPointforCHFManagementCheckPointforCHFManagementDryDryDryDry+ + + +WarmWarmWarmWarmBNP200BNP200BNP200BNP200ReverseRemodelingReverseRemodelingReverseRemodelin
25、gReverseRemodelingHospitalizationHospitalizationHospitalizationHospitalizationLethal/DisabilityLethal/DisabilityLethal/DisabilityLethal/DisabilityTherapeuticplanTherapeuticplanTherapeuticplanTherapeuticplanFundamentalTXFundamentalTXFundamentalTXFundamentalTXAdjunctiveTXAdjunctiveTXAdjunctiveTXAdjunc
26、tiveTXReinforceTXReinforceTXReinforceTXReinforceTXDefaultDefaultDefaultDefaultLVAD/HTXLVAD/HTXLVAD/HTXLVAD/HTXTotalBililbinTotalBililbinTotalBililbinTotalBililbinCareCareCareCare/ / / /HospiceHospiceHospiceHospice谢仅坠筛殆酸翘狐凹富步磅钠碾糙抨瓷程裤斯排剥票潘南环粪断荷抠勿废如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化Anti-RemodelingandReverseRemode
27、lingAnti-RemodelingandReverseRemodelingMancinidMancinidMancinidMancinid &Burkhoff&Burkhoff&Burkhoff&Burkhoff， ， ， ，Circulation,2005Circulation,2005Circulation,2005Circulation,2005AcuteHeartFailureAcuteHeartFailureChronicHeartFailureChronicHeartFailure烧握钻宅设汀跌病饰届舌蚌高突孪挫桶聚乙造宽逢舶亿乖鹏牢满膨揪尺虱如何避免慢性心力衰竭恶化如何避免慢
28、性心力衰竭恶化PrimaryEndpoint(J-WIND)PrimaryEndpoint(J-WIND)EjectionFraction(EF)inChronicStageEjectionFraction(EF)inChronicStageKitakazeKitakazeKitakazeKitakazeMet.alMet.alMet.alMet.alLancetLancetLancetLancet2007;370:14832007;370:14832007;370:14832007;370:1483ControlControl（ （ （ （ n=187n=187n=187n=187 ） ）
29、） ）NicorandilNicorandil（ （ （ （ n=190n=190n=190n=190 ） ） ） ）p=0.460p=0.460p=0.460p=0.460363636364040404044444444484848480 0 0 0(%)(%)(%)(%)ControlControl（ （ （ （ n=199n=199n=199n=199 ） ） ） ）ANPANPANPANP（ （ （ （ n=155n=155n=155n=155 ） ） ） ）363636364040404044444444484848480 0 0 0(%)(%)(%)(%)p=0.024p=0.02
30、4p=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駆出出出出率率率率43.2%43.2%43.2%43.2%42.5%42.5%42.5%42.5%44.7%44.7%44.7%44.7%42.5%42.5%42.5%42.5%篓描零吞自衫拭瞄窥腋介凑鞠缴没澈矮勿八心郊威钻龙虱肋五羔嘱盔拷走如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化ThePREAMIInvestigators,ArchInternMed2006ThePREAMIInvestigators,ArchInternMed2006A
31、nti-rAnti-remodeling&emodeling&PerindoprilPerindoprilIn刻撇骤巳尸赐蛰从道够捌愿社窥抵谜嗣驶恰涛泞糊奋初闪枕烹丁沤拼炬哗如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化SixMonthsBNP&CVEventsSixMonthsBNP&CVEventsCVeventObservation（Mo）0.00.10.20.30.40.50.60.70.80.91.0681012141618202224P0.0001P380pg/ml,n=14BNP：190to380pg/ml,n=20BNP：190pg/ml,n=49NishiiMetal:Ni
32、shiiMetal:NishiiMetal:NishiiMetal:NishiiMetal:NishiiMetal:JACC51(24):2329-35,2008JACC51(24):2329-35,2008JACC51(24):2329-35,2008JACC51(24):2329-35,2008JACC51(24):2329-35,2008JACC51(24):2329-35,2008多塞吟睦鸦丸扒水害溪凸屡撬献付犹烛牟纂丛庸左嗣遂屏泌贷肤付壳殆蹿如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化LVEF (%)P=0.000101020304050at dischargeat 6 mont
33、hsLVEF (%)P=0.000101020304050at dischargeat 6 monthsLVEF (%)P=0.000101020304050at dischargeat 6 monthsLVEF (%)P=0.000101020304050at dischargeat 6 monthsLVEF (%)P=0.000101020304050at dischargeat 6 monthsLVEF(%)atdischargeat6monthsLVEF(%)P=0.00010102030405001020304050atdischargeat6monthsSixMonthsBNP&S
34、ixMonthsBNP&ReverseRemodelingReverseRemodelingLVDd (cm)P=0.00555.566.57at dischargeat 6 monthsLVDd (cm)P=0.00555.566.57at dischargeat 6 monthsLVDd (cm)P=0.00555.566.57at dischargeat 6 monthsLVEFatdischargeat6monthsP=0.005LVDd(cm)55.566.57LVDd(cm)55.566.57atdischargeat6monthsLVDd:BNP190NishiiMetal:Ni
35、shiiMetal:NishiiMetal:NishiiMetal:NishiiMetal:NishiiMetal:JACC51(24):2329-35,2008JACC51(24):2329-35,2008JACC51(24):2329-35,2008JACC51(24):2329-35,2008JACC51(24):2329-35,2008JACC51(24):2329-35,2008篮席孕度斩竿灰说巍绑凸尽粟骤裸六得湃埔缨乏属豌柔虐涩辗噎躁禄牌址如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化-5-5-5-50 0 0 05 5 5 510101010151515152020202025
36、25252530303030ThepercentagechangeinLVDs(%)ThepercentagechangeinLVDs(%)ThepercentagechangeinLVDs(%)ThepercentagechangeinLVDs(%)BNP190pg/mlBNP190pg/mlBNP190pg/mlBNP190pg/mlBNP190pg/mlBNP190pg/mlBNP190pg/mlBNP190pg/ml(LVDsatpost-discharge6month(LVDsatpost-discharge6month(LVDsatpost-discharge6month(LVDs
37、atpost-discharge6month LVDsatdischarge)/LVDsatdischarge)/LVDsatdischarge)/LVDsatdischarge)/LVDsatdischargex100LVDsatdischargex100LVDsatdischargex100LVDsatdischargex100P=0.003P=0.003P=0.003P=0.003202020205555-0.5-0.5-0.5-0.51111SixMonthsBNPSixMonthsBNP ReverseRemodelingReverseRemodeling媚颊容网迪预爆朴材温疑募渊荧
38、搀祝讥内尿剑课藕邪署今印袍靴樱室屋痈如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化孽妄塞辈辨酌远面昆纬褒免柑屯割烘然析玲姑嗅朱伤递碰翠亦寡坤委拐执如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化Summary1.BNPguidedtherapyproducesasuperiorandexcellentoutcomethroughphysiciansawarenesstowardtheirpropertreatment.2.However,theBNPmeasurementisnotalmightydiagnostictoolleadingtocomprehensiveCHFmanagement.3.Asanewcheckpoint,“anti-remodeling/reverseremodelingshouldbeselectedwithcareasastrongcandidate.幕蟹锈翟憾缴省樟膘雪响苍艇胺美赤秀怠雁终荆线屹悬屡琼干粹腹面属谗如何避免慢性心力衰竭恶化如何避免慢性心力衰竭恶化
