射血分数正常心力衰竭.pptVIP

 射血分数正常的心力衰竭 Epidemiology 临床特点 症状和体征：收缩功能不全vs舒张功能不全 病理生理机制 舒张功能不全的压力-容积环 收缩期和舒张期时相 诊断标准 舒张功能不全分期 B型脑钠肽，BNP B型脑钠肽，BNP Summary（总结） DHF is not at all rare and may account for a large number of the hospitalization Clinical and echocardiographic criteria are still imperfect（临床和超声检查标准尚不完善） Incorporation of BNP measurement may increase the accuracy of diagnosis Further evidence of treatment should be available from randomized therapeutic trials Circulation. 2003;107:659-663 Maisel A. S., et al, from the Division of Cardiology and Department of Medicine, Veteran’s Affairs Medical Center and University of California, San Diego: Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. August 2000. Maisel A. S., et al, from the Division of Cardiology and Department of Medicine, Veteran’s Affairs Medical Center and University of California, San Diego: Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. August 2000. * 血浆BNP 或NT-proBNP: 如BNP＞200pg/mL 或NT-proBNP＞220pg/mL, 同时要有以下证据: TD(E/E’ ratio); E/A ratio and DT combined LV mass index or LA volume index ECG 确定的AF 如BNP＞400pg/mL 或NT-proBNP＞2000pg/mL可能HF * 排除HFNEF的条件: (1) 如病人诉呼吸困难, 不伴体液负荷, BNP＜100pg/mL 或NT-proBNP＜120pg/mL, 可除外任何形式的心衰。 (2) 如LVEF＞50%、 LVEDVI＜76mL/M2、 无AF、无心房扩张、无LVH, 无高的TD E/E’, HFNEF的诊断可除外 * 如何诊断左室射血分数保留的心衰:ESC 共识 HF的症状或体征 LVEF 50% 且 左心室舒张末期容积指数(LVED VI) 97 ml/m2 左心室舒张、充盈、舒张期膨胀和僵硬度异常 肺动脉楔压 12 mm Hg 或 左心室舒张末压 16 mm Hg 组织多普勒 NT proBNP 220 pg/ml BNP 200 pg/ml E/E’ 15 15 E/E’ 8 超声血流多普勒 : . E/A DT . 肺静脉血流 .左房扩大 . 左心室肥厚 .房颤 NT proBNP 220 pg/ml or BNP 200 pg/ml HFNEF 组织多普勒 E / E’ 8 From Paulus Eur Heart J. 2007 * 治疗 * Swedberg et al. Eur Heart J. 2005:26;1115-1140. ESC关于HF-PS