心力衰竭辅助检查.pptVIP

心肌活检 对不明原因的心肌病诊断价值有限，但有助于明确心肌炎症性或浸润性病变的诊断 Thanks * * * * * * * * * * While the use of BNP for screening in the general population is not currently warranted, targeted screening of individuals at high risk of developing left ventricular systolic dysfunction would lead to more economical use of more expensive cardiac imaging procedures such as echocardiography or ultrasound. Many studies have shown that fewer than 30% of symptomatic patients referred for echocardiography turned out to have heart failure. A reliable rule-out test for CHF, with an Negative Predicative Value (NPV) of 98% or better, when used on the above population could eliminate unnecessary testing in ~68% of the symptomatic population. Additionally, a number of other utilities can be envisioned wherein BNP could be used to predict outcome, progression or response to therapy of disorders characterized by impaired cardiac function. BNP is a very active research topic today. There is no doubt that future studies will focus much time on these other potential uses of BNP. BNP has also been shown to be a useful prognostic indicator. BNP values increase as CHF progresses in severity. Increasing BNP values also correlate with the NYHA Classes and left ventricular ejection fraction. These are discussed in greater detail in slides 9-11. Since BNP appears to be the most powerful neurohormonal predictor of left ventricular function, a new area of clinical research is supporting the use of BNP in selecting patients for specific drug therapy. Studies are also being conducted to provide guidance to physicians in determining the proper dosage of these various drugs. * * 心力衰竭辅助检查 辅助检查 BNP 胸片 心电图 超声心动 核素 血流动力学 心肌活检 利钠肽 是心肌细胞产生的一种神经激素，其主要功能是增加尿/钠排泄，降低血管紧张素-醛固酮引起的血管收缩及血压升高。cNP有三种，分别是ANP、BNP、CNP。 B型脑利钠肽BNP（brain natriuretic peptide） BNP: 心衰定量标志物 促进排尿利钠 抑制RAA ANP BNP = CNP 体积? 压力 ? 左室收缩功能障碍 + 左室舒张功能障碍 + 瓣膜功能障碍 + 右室功能障碍 降低外周血管抵抗 (降低血压) 抑制肾素－血管紧张素－醛固酮的分泌， 提高肾小球滤过率，利钠、利尿 舒张血管平滑肌、扩