室性心律失常合并慢性心力衰竭和猝死.pptxVIP

室性心律失常合并慢性心力衰竭和猝死防治概况心脏猝死发生率1~2/10万人/年90%的心脏猝死继发于室性心律失常（室速、室扑、室颤、TDP、无脉性电活动）猝死可以发生于任何人群，尤其是器质性心脏病（特别是缺血性心脏病）合并心衰人群。 充血性心力衰竭与猝死自ACE阻滞剂，?阻滞剂等药物的应用，病死于泵衰竭的患者明显减少然而，有症状的心力衰竭患者在确诊后2.5年内，仍有20%-25%患者发生意外死亡，而其主要原因（超过50%）为VT/VF引起的猝死。室性心律失常猝死心力衰竭Care-HF 患者死亡原因CARE-HF Extension StudyTime to Sudden Death两年的随访中两条曲线趋势一致1.00CRTMedicalTherapy0.75Hazard Ratio 0.54 (95% CI 0.35 to 0.84; P=0.006)0.50SurvivalMain Study：CRT = 29 sudden deaths （7.1%）Medical Therapy = 38 sudden deaths (9.4%）CRT = 32 sudden deaths (7.8%)Medical Therapy = 54 sudden deaths (13.4%)0.250.00040080012001600Time (days)Main Study 平均随访时间：29.4mExtension Study 平均随访时间：37.6m Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the Cardiac Resynchronziation-Heart Failure (CARE-HF) trial extension phase]. Eur Heart J 2006; 16: 1928 – 32 LVEF与SCA的相关性7.5%5.1%% SCA Victims2.8%1.4%LVEF Gorgels, PMA Out-of-hospital cardiac arrest-the relevance of heart failure.The Maastricht Circulatory Arrest Registry.European Heart Journal.2003;24:1204-1209.左室功能不全的CHF患者中SCD率Control Group Mortality %45 months 13 months41.4 months27 months12 months16 months6 months总死亡率 ~15-40%; SCD 占总死亡的 ~50%.尽管给予理想的药物治疗，心衰患者的猝死率仍非常高1 MERIT-HF Study Group.Effect of metroprolol CR/XL in chronic heart failure.Lancet.1999;353:2001-2007.2 CIBIS Investigations and Committees.The cardiac insufficiency bisprolol study II (CIBIS-II).Lancet.1999;353:9-13.3 Packer M,Bristow MR,Cohn JN,et al.The effect of carvedilol on morbitity and nortality in patients with chronic heart failure.U.S.Carvedilol Heart Failure Study Group.N Engl J Med.1996;334:1349-1355.4 The RALE Investigators.Effectiveness of spironolactone added to an aniotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure(the Randomized Aldactone Evaluation Study[RALES].Am J Cardiol.1997;78:902.2006年室性心律失常和猝死预防指南（心衰部分）I级推荐1、对于LVEF40%,已经接受了长期最佳药物治疗并且预期至少可以以良好状态的存活大于1年的患者，或者那些从室扑，血液动力学不稳定型的室速以及造成晕厥的室速中存活下来的患者，ICD治疗被建议当做二级预防来防治猝死的发生。（A类证据）