心力衰竭药物治疗新证据与新视野PPT.ppt

Impact of ISDN-hydralazine on mortality and morbidity of African-American patients with Heart Failure A-Heft Trial Isosorbide dinitrate (ISDN) plus hydralazine Tablet containing 20 mg ISDN and 37.5 mg hydralazine (BiDil?, NitroMed) 3X daily. Dosage could be doubled by enrolling physician. n=518 44.2% female 44.8% diabetic Primary Endpoint: Weighted composite of all-cause death, first hospitalization for heart failure, and change in quality of life at a mean follow-up of 10 months A-Heft Trial Presented at AHA 2004 Placebo n=532 36.1% female 37.0% diabetic 1,050 African-American patients with advanced heart failure New York Heart Association (NYHA) class 3-4 for 3 months LV function 35% ( 40% if LV dilated per echo) 90% receiving diuretics, 69% ACE-inhibitor, 17% angiotensin receptor blocker, 74% beta-blocker 心力衰竭药物治疗新证据与新视野 李勇 复旦大学附属华山医院心脏科 上海 200040 治疗心力衰竭的药物 1、强心苷类药物 2、利尿剂 3、ACE抑制剂及血管紧张素II（AT1）受体拮抗剂 4、?受体阻断剂 5、其他治疗CHF的药物： （1）钙拮抗剂 （2）磷酸二酯酶抑制剂 （3）其他血管扩张剂：长效硝酸酯类，肼苯哒嗪 DIG 研究 50 40 30 20 10 0 Placebo n=3403 Digoxin n=3397 48 0 12 24 36 Mortality % N Engl J Med 1997;336:525 Months p = 0.8 Digitalis N=6800 NYHA II-III 0.6 Probability of Death 0 Placebo (273)Prazosin (183)Hz + ISDN (186) Months 0.7 0.5 0.3 0.4 0.2 0.1 N Engl J Med 1986;314:1547 Nitrates 0 6 12 18 24 30 36 42 V-HeFT-I研究 combination of hydralazine (300mg/day) and isosorbide dinitrate (160mg/day 23% reduction in mortality Placebo Enalapril 12 11 10 9 8 7 6 5 Probabiility of Death Months 0.1 0.8 0 0.2 0.3 0.7 0.4 0.5 0.6 p 0.001 p 0.002 N Engl J Med 1987;316:1429 4 3 2 1 0 CONSENSUS 研究 253 patients with class IV heart failure Enalapril： 2.5-40mg/day 31% reduction in mortality 卡维地洛 n=696 安慰剂 n=398 存活 天 0 50 100 150 200 250 300 350 400 危险度下降=65% p0.001 Packer et al (1996) CIBIS-II Investigators (1999) 比索洛尔 安慰剂 接收后的时间 (天) p0.0001 存活 危险度下降=34% The MERIT-HF Study Group (1999) 美国卡维地洛计划 CIBIS-II 0.8 1.0 0.6 0 随访月 0 3 6 9 12 15 18 21 20 15 10 5 0 安慰剂 美托洛尔 CR p=0.0062 危险度下降=34% MERIT-