课件：CR治疗在心力衰竭中的应用李琼.ppt

* * * * By examining the Kaplan-Meier survival curves, we note that the ICD benefit began after approximately one year. Importantly, as demonstrated by the widening of the curves over time, the ICD benefit appears to increase over time. In an important recent analysis, Dr. Moss announced that there was a 40% cumulative probability of appropriate ICD therapy (ATP or shock) for VT or VF during the 4-year follow-up after ICD implantation. This finding clearly shows the improving cost-effectiveness of ICD therapy with longer follow-up periods.[i]  [i] Moss, Arthur. MADIT I and MADIT II. Journal of Cardiovascular Electrophysiology. Vol. 14, No. 9, September 2003 * * 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