体外反搏与心功能保护-课件，幻灯，.ppt

体外反搏与心功能保护 伍贵富 中山大学附属第一医院心内科 卫生部辅助循环重点实验室 2009.8.22 大连 心力衰竭治疗存在的问题 心力衰竭的非药物治疗 EECP 1:1 Mode ANP and BNP CAD Patients with History of CHF PEECH? TrialProspective Evaluation of EECP in Congestive Heart Failure N=187 patients randomized to: EECP therapy plus optimal medical therapy Optimal medical therapy alone 29 centers participating including Cleveland Clinic, Scripps Clinic, Thomas Jefferson and UCSD Co-Primary endpoints at six months following treatment (90% Power) Exercise Tolerance: % of patients with 60 second increase from baseline or Peak VO2: % of patients with 1.25 ml/min/kg increase from baseline Blinding: blinded central core lab evaluated exercise data; blinded investigators performed subject evaluations; patients not blinded Secondary endpoints: Change in exercise duration and peak VO2, change in NYHA class, change in Quality of Life PEECH PEECH Trial: Endpoints Primary Percentage of subjects with at least a 60-second increase in exercise duration from baseline to six months OR Percentage of subjects with at least 1.25 ml/min/kg increase in Peak VO2 from baseline to six months Secondary Changes in exercise duration and Peak VO2 Changes in NYHA classification Changes in quality of life Adverse experiences PEECH: Patient Demographics PEECH: Subjects with Ischemic Etiology PEECH: Subjects with Ischemic Etiology PEECH: Exercise Duration PEECH: Peak VO2 PEECH研究结论 与最佳药物治疗组比较，体外反搏治疗可以改善NYHA II/III心功能且LVEF ? 35%患者的运动耐量、生活质量和心功能状态 缺血性心脏病和高龄患者（65岁以上）获益更多 PEECH研究结果与既往的 MUST-EECP和临床注册研究结论相似 后续的注册研究显示，心绞痛合并心力衰竭（病情稳定者）者，上述获益在随访1－2年后仍然保持 Feldman AM, et al. J Card Fail Apr 2005;11:240-245. All NS 73 (77.7%) 18 (19.1%) 81 (86.2%) 70 (75.3%) 18 (19.4%) 79 (84.9%) HF Treatment - ACEI - ARB - Beta blocker NS NS 62 (66.0%) 32 (34.0%) 60 (64.5%) 33 (35.5%) NYHA Class II Class III NS 26.7 (6.5) 25.9 (6.1) LVEF (mean %, SD) NS 66 (70.2%) 64 (68.8%) Etiology Ischemic NS 63.0 (10.4) 62.4 (11.7) Age (mean yrs, SD) NS 75 (79.8%) 76 (81.7%