CRT治疗在心力衰竭中应用李琼.pptVIP

* * Main purpose: Set up discussion for next slide. Key messages: Despite the significant contributions of ACE inhibitors and beta blockers to help heart failure patients live longer, the annual mortality of heart failure patients remains high. As previously shown, moderate to severe heart failure patients with a wide QRS are at higher risk. Cardiac resynchronization and ICD therapies can help this higher risk group live longer Additional information: SOLVD-T was a landmark trial reported in 1991 that showed ACE inhibitors reduced mortality in symptomatic heart failure patients. The MERIT-HF (metroprolol study in Europe and North America) and the CIBIS II (bucindilol in Europe) studies reported in 1999, demonstrated that the addition of beta blockade to conventional treatment, including ACE-inhibitors, further improved survival. The results from these trials are consistent with those reported from the US cardvedilol trial. As reported in the same review paper, if one extracts NYHA III/IV patients from the combined CIBIS II, MERIT-HF and US carvedilol trials, 1- year mortality in the control and treatment groups are 15.15 and 9.5% respectively. * This figure presents sequential changes of left ventricular ejection fraction (A), exercise capacity (functional capacity score) (B), and changes in left ventricular end-systolic volume (C) in patients with sinus rhythm (SR) and atrial fibrillation (AF) with and without atrioventricular junction (AVJ) ablation. Significance values within the single groups are given in Tables 2 and 4. Also included (D) below the legend are the total number of patients reaching the different follow-up visits and the number of deaths that occurred in the time interval since last follow-up. * The LV normally contracts synchronously with little more than 40 ms variation in the onset of electrical activation throughout the wall and very similar low-level variability in the timing of mechanical activation as well. Synchrony of contraction