从的指南看心衰进展.pptVIP

As PRIDE was performed to evaluate the importance of NT-proBNP results relative to clinical judgment, these variables were put into an ROC analysis. Clinical judgment had excellent area under the ROC of 0.90; NT-proBNP alone had an area under the ROC of 0.94, which was significantly better than clinical judgment alone, however the combination of NT-proBNP PLUS clinical judgment was superior to either alone. This sends the reassuring message that biomarker testing together with clinical judgment is the superior approach to evaluation of acute dyspnea.AUC：ROC曲线下面积 Seen here are the data from Bettencourt and colleagues. As depicted, those who had robust reduction (30%) in their NT-proBNP concentrations after treatment for acute HF had the best outcomes, while those who actually had a rise in their values during treatment had nearly universal adverse outcome, and those with intermediate change in their NT-proBNP had—as would be predicted—intermediate outcomes. 指南原文： suspected AHF makes the diagnosis unlikely (thresholds: BNP ﹤100 pg/mL, NT-proBNP ﹤300 pg/mL,MR-proANP ﹤120 pg/mL). * 2016年心衰会议强调“无症状，无心衰”。心衰诊断新法则增加NT-proBNP切割值排除法。 * 指南原文： However, elevated levels of NPs do not automatically confirm the diagnosis of AHF, as they may also be associated with a wide variety of cardiac and non-cardiac causes * 指南原文： 1 Clinical classification can be based on bedside physical examination in order to detect the presence of clinical symptoms/signs of congestion(‘wet’ vs. ‘dry’ if present vs. absent) and/or peripheral hypoperfusion(‘cold’ vs. ‘warm’ if present vs. absent) 2 The combination of these options identifies four groups: warm and wet (well perfused and congested) —most commonly present; cold and wet (hypoperfused and congested); cold and dry (hypoperfused without congestion); and warm and dry (compensated, well perfused without congestion). 3 This classification may be helpful to guide therapy in the initial phase and carries prognostic information * 充血表现：肺充血，端坐呼吸，外周水肿，