糖尿病与心衰发生机制及诊疗现状课件.pptVIP

病生机制和诊断重要进展 心室重塑和心肌细胞凋亡是心力衰竭的重要病理生理机制，抑制心力衰竭时神经内分泌的过度激活是降低心力衰竭患者死亡率的重要方法。 心导管检查和放射性核素心血管造影可以准确检测心脏收缩舒张功能，多谱勒超声心动图也是临床判断心脏收缩舒张功能简便和准确的方法，有床旁诊断价值。 舒张性心力衰竭（Diastolic Heart Failure） 为心力衰竭的一种特殊类型，是指各种疾病导致心室的舒张功能障碍但心室收缩功能尚正常而引发的临床综合征。目前的资料表明，充血性心力衰竭病人中约20-40%为单纯舒张性心力衰竭。 Coronary artery disease is the cause of HF in about two thirds of patients with left ventricular systolic dysfunction. The remainder have a nonischemic cardiomyopathy, which may have an identifiable cause (e.g., hypertension, thyroid disease, valvular disease, alcohol use, or myocarditis) or may have no known cause (e.g., idiopathic dilated cardiomyopathy). Diabetes is the leading cause of blindness in patients aged 20-74 years. Diabetes is also the leading cause of end-stage renal disease. Approximately 60-70% of patients with diabetes develop some degree of neuropathy, including erectile dysfunction. 60-70% of all diabetes-related deaths are attributable to the macrovascular manifestations of the disease. Diabetic vascular disease is responsible for a 2- to 4-fold increase in the incidence of coronary heart disease (CHD) and stroke and a 2- to 8-fold increase in the risk for heart failure. Diabetes have a 15- to 40-fold increased risk for lower extremity amputations. During 13,811 person-years of follow-up, 173 subjects developed incident heart failure, as confirmed by chart review. Five factors were independent predictors of heart failure: male sex (RR = 1.7; CI, 1.3 to 2.4), older age (RR = 1.9; CI, 1.3 to 2.7 for age 75 to 84 years, RR = 3.0; CI, 1.7 to 5.5 for age 85 years and older, compared with or = 74 years), diabetes (RR = 2.9; CI, 2.0 to 4.3), pulse pressure or = 70 mm Hg (RR = 2.3; CI, 1.3 to 4.3, compared with 50 mm Hg), and body mass index or = 28 kg/m2 (RR = 1.6; CI, 1.0 to 2.4, compared with 24 kg/ m2). Myocardial infarction occurred during follow-up in 8% of the cohort and was also an important predictor of heart failure (RR = 21; CI, 15 to 31). Diabetic cardiomyopathy?Spector