如何避免慢性心力衰竭恶化PPT.ppt

Tohru Izumi, Toshimi Koitabashi, Mototsugu Nishii, Takayuki Inomata Department of Cardio-Angiology, Kitasato University School of Medicine, Sagamihara 288-8555, Japan Oct 23rd, 2008, Beijing, How to Prevent From Worsening of Chronic Heart Failure The 4 th China-Japan Cardiovascular Forum (CJCF) Chronic Heart Failure and Disease Burden Burden Aging CV Event CV Event BNP guided therapy for CHF patient Reduction of cardiac event (disease burden) Indicator: BNP CHF ACEI+BB Tx Comprehensive management Diuretics ０　　　　１８　　　 ４０　　　１００　　 ２００　　５００　pg/mL　 ＢＮＰ scale * Plasma BNP level is titrated by RIA using Shionoria (Shionogi, Osaka) After discharge with/without BNP guided Follow up period after discharge (days) 1.0 0.6 0.8 0 0.2 0.4 0 200 400 600 Cardiac-event -free survival Clinical guided Tx BNP guided Tx p=0.0435 readmission rate 365 days 16.6% 31.5% ?In two years follow-up, there were significantly lower cardiac events, readmission, in BNP guided Tx in comparison with the clinical guided Tx. Cumulative rate of the event within one year reduced from 31.5 to 16.6%. Inomata T, et al. Jpn Circ J 2001;65 (S-1A), 282. Cost-effectiveness of BNP gTx QALY (quality adjusted life year) Years Costs ＄ ＊ ＊ ＊ Morimoto T, Izumi T, Fukui T et al, Int J Cardiol,　2004 Clinical Indicator Check Point for CHF Management Dry+Warm BNP200 New Index? Hospitalization Lethal/Disability Therapeutic plan Fundamental TX Adjunctive TX Reinforce TX Default LVAD/HTX Total Bililbin Care/Hospice Remodeling vs. Reverse Remodeling Cardiac Resynchronization Therapy (CRT) vs. Reverse Remodeling Before CRT Two weeks later One year later Echocardiogram（TMF）after CRT Before CRT One year later Reverse Remodeling and β-Blocker（Carvedilol） △LVEF (%) P=0.018 6.6 8.7 13.2 JPN MUCHA Carvedilol (n=37) (n=40) (n=66) △LVEF (%) P0.001 2 7 10 US MOCHA 8 Carvedilol (n=62) (n=75) (n=75) (n=81) 0 5 10 15 Placebo 6.25mg bid 12.5mg bid 25mg bid Dilated Cardiomyopathy vs. Reverse Remodeling Immunohistochemical Stainin