正常射血分数心力衰竭(HF-PEF)诊断和治疗进展推荐.pptVIP

* 482 patients underwent screening for diastolic dysfunction. For the 384 patients who fulfilled entry criteria, the screening echocardiograms served as their baseline measurements. These patients were randomized to blood pressure lowering with valsartan, titrated to 320mg qd, or without inhibiting the renin angiotensin aldosterone system, and treated for 38 weeks. Investigators were instructed to treat blood pressure to target in all patients, utilizing a menu of concomitant blood pressure medications consisting of diuretics, beta or calcium channel blockers, or alpha blockers. Patients were not allowed to received additional inhibitors of the renin-angiotensin-aldosterone system. At the conclusion of 38 weeks, patients underwent a repeat echocardiographic examiniation. The primary endpoint of the trial was change in annular relaxation velocity, or lateral E’, from baseline to 38 weeks. Secondary enpoints of diastolic function, including IVRT, S’, deceleration time were measured, as were measures of cardiac structure. * The primary endpoint, mitral annular relaxation velocity, increased significantly in both groups, from 7.5 to 8.0 in the valsartan group, and from 7.,5 to 7.8 in the non-RAAS group…. Representing a 0.44 cm/s increase in the placebo group and and a 0.60 increase in the valsartan, with widely overlapping confidence intervals, and a between group p-value of 0.30. * Change in systolic blood pressure was inversly related to improvement in annular relaxation velocity (E’), even after adjusting for baseline blood pressure, baseline E’, age and treatment group, although this relationship was non-linear. Patients with 10mm Hg or greater blood pressure reduction had the greatest degree of improvement in relaxation velocity. * * 2007-IRBE-RAF-MD-0001-I Excel HF Module GLB.IRB.07.10.11 如前所述，I-PRESERVE研究的主要终点是全因死亡或心血管住院的时间。其中心血管住院原因包括： ? 心衰加重 ?不稳定心绞痛 ?心肌梗死 ?室性心律失常 ?房性心律失常 ?卒中 任何一次住院期间发生心梗或卒中也被认为是心血管住院 I-PRESERVE 结果 （/1000人年） IR