HFpEF都是水惹的祸.pptVIP

* The cause for chronotropic incompetence is unknown and may be due to abnormalities in β-adrenergic signaling [43] or to autonomic dysfunction, as these patients have also been shown to display reduced heart rate recovery, abnormal baroreflex sensitivity and enhanced cardiac sympathetic stimulation HFpEF: 都是水惹的祸吗？ 广东省人民医院 心内科 黎励文 定义：HFpEF（Heart Failure with preserved Ejection Fraction），射血分数保存的心力衰竭（EF45%），又称射血分数正常的心力衰竭，临床上习惯称舒张性心力衰竭（ACC/AHA guidelines） 心功能不全/心衰症状、体征 阴性的血管学检查 超声发现尚存的左心EF HFpEF 流行病学 国内： 约有20%-60%的慢性心衰病人属于HFpEF，且多发生在老年、女性、肥胖、有高血压、房颤、糖尿病史的人群中； 国外：population-based的调查显示半数的心衰病人有HFpEF，不同的流行病学研究结果从40-71%（平均56%）不等，hospital-based调查24-55%（平均41%） 发病率、高危因素基本一致 二种类型心力衰竭的比较 收缩性心衰(HF-REF)： 典型症状(气促、水肿、疲劳) 典型体征(颈静脉充盈、啰音、心尖搏动弥散) LVEF↓ 射血分数保留的心衰(HF-PEF)： 典型症状 典型体征 LVEF正常或轻度下降，且LV无扩大 心脏结构改变(LV肥厚/LA扩大)和/或舒张功能不全 RAAS 容量/利尿 改善心肌 顺应性 Meta-analysis, I-Preserve Study RAAM-PEF Trial Systematically review and evaluate prospective clinical studies of RAS inhibitors enrolling patients with HF-PEF(3 trials, CHARM-Preserved, I-PRESERVE, PEP-CHF) Results: no clear benefit with regard to all-cause mortality or HF hospitalization. I-Preserve Study 4128 patients60 years old NYHA class II, III, or IV heart failure with an EF45% Randomly assigned to receive irbesartan 300mg/d or placebo 49.5 months’ mean follow-up I-Preserve Study RAAM-PEF Trial A randomized, double-blind, placebo-controlled trial of 44 patients with HFPEF Eplerenone and placebo 6 months’ treatment RAAM-PEF Trial RAAM-PEF Trial eplerenone was not associated with an improvement in exercise capacity compared to placebo eplerenone associated with significant reduction in markers of collagen turnover and improvement in diastolic function Whether these favorable effects will translate into morbidity and mortality benefit in HFpEF remains to be determined RAAM-PEF Trial结论中提到eplerenone 的作用机制仅有极轻的利尿作用，主要在于 改善心肌重构 是否都是水惹的祸？从利尿治疗 对于HFPEF的有效性尚不能得出 结论，也缺乏循证医学根据 到底什么在起 作用？ HFpEF病理生理特点 1.心室主动松弛能力受损：Ca2+ATP酶表达减少或活性降低，肌浆网磷