安博维IRESERVE和舒张性心衰.ppt

Heart Failure (HF) is a progressive entity, generally starting with asymptomatic systolic ventricular dysfunction (AVSD) and ending with symptoms which are produced by fluid retention and finally leading to refractory heart failure with systemic hypoperfusion. Therefore the HF concept has been broadened thus including, on one end of the spectrum; patients with volume overload and reduced ejection fraction (EF) and on the other end asymptomatic patients with important systolic and diastolic derrangements.In order to understand the benefit exerted by some of these drugs on this population, it is important to bear in mind some of the pathophysiological characteristics that associate a myocardial insult to symptoms manifestation. Coronary disease causes about 60%-70% of HF cases. Other etiologies include: valve disease cardiomyopathy and pressure or volume overload. Setting the cause aside, ventricular dysfunction appears and from that moment on a series of mechanisms will be seen. They are as follows: neurohormonal and aldosterone-renin-angiotensin system activation, endothelial dysfunction and an interplay between vasodilators and vasoconstrictors substances. This will cause a ventricular remodeling process with a consequent fall in EF, which will lead to a clinical HF phase and will end-up in severe pump failure with arrhythmias and death. 071016a_Irbe GLB.IRB.07.10.11 心衰的患病率 据估计，全世界有23,000,000例心衰患者.1 其中大约一半（40-71%，平均56%）收缩功能尚存。 经过多年来对左心室收缩功能降低(收缩性心衰)的关注后，现在人们对收缩功能尚存的心衰综合征越来越感兴趣。既往左心室射血分数降低被作为大多数心衰治疗研究的主要入选标准，使得临床对收缩功能尚存的心衰的诊断和治疗有些偏倚。 该幻灯显示了心衰流行病学研究中左心室收缩功能不全(LVSD)与收缩功能尚存患者的比例2,3 。 参考文献: 1. Cleland JG et al. The heart failure epidemic: exactly how big is it? Eur Heart J 2001; 22: 623-626. 2. Petrie M, McMurray J. Changes in notions about heart failure. Lancet. 2001;358:423-434 3. Hogg K, Swedberg K, McMurray J. Heart Failure with preserved systolic function. J Am Coll Card. 2004;43:317-327. * 071016a_Irbe GLB.IRB.07.10.11 Mortality in patients with heart