如何避免慢性心力衰竭惡化

1、Tohru Izumi, Toshimi Koitabashi, Mototsugu Nishii, Takayuki InomataDepartment of Cardio-Angiology, Kitasato University School of Medicine, Sagamihara 288-8555, Japan,Oct 23rd, 2008, Beijing,,How to Prevent From Worsenin

2、g of Chronic Heart Failure,The 4 th China-Japan Cardiovascular Forum (CJCF),Chronic Heart Failure and Disease Burden,BNP guided therapy for CHF patient,,,,,,,,,,,Reduction of cardiac event (disease burden),Indicator

3、: BNP,CHF,ACEI+BB Tx,Comprehensive management,Diuretics,* Plasma BNP level is titrated by RIA using Shionoria (Shionogi, Osaka),?In two years follow-up, there were significantly lower cardiac events, readmission, in BNP

4、guided Tx in comparison with the clinical guided Tx. Cumulative rate of the event within one year reduced from 31.5 to 16.6%.,Inomata T, et al. Jpn Circ J 2001;65 (S-1A), 282.,Group I,Group II,SR,SR,Af,Af,Koitabashi T, I

5、nomata T, et al. ESC 2004,BNP guided Tx cancelled out prognostic contribution by AF in CHF management,Altered prognosis of Af Pts by introducing BNP guided Tx,HF-event-free survival(%),Group IIBNP guided era(‘00-02),Gro

6、up IClin guided era (‘96-98),BNP and Arrhythmic Prognosis,KITASATO UNIVERSITY,Cost-effectiveness of BNP gTx,Morimoto T, Izumi T, Fukui T et al, Int J Cardiol,　2004,Clinical Indicator,Check Point for CHF Management,,,,,,

7、,,,,Dry+Warm,BNP<200,New Index?,Hospitalization,Lethal/Disability,,Therapeutic plan,,,,Fundamental TX,Adjunctive TX,Reinforce TX,Default,LVAD/HTX,,Total Bililbin,Care/Hospice,Cardiac Resynchronization Therapy (CRT) vs

8、. Reverse Remodeling,Before CRT,Two weeks later,One year later,Echocardiogram（TMF）after CRT,Before CRT,One year later,Reverse Remodeling and β-Blocker（Carvedilol）,Dilated Cardiomyopathy vs. Reverse Remodeling,,,Immunohis

9、tochemical Staining for NFκB,Wohlschlaeger J, Baba　AH et al, Cardiovas Res、2005,Clinical Indicator,Check Point for CHF Management,,,,,,,,,,Dry+Warm,BNP<200,Reverse Remodeling,Hospitalization,Lethal/Disability,,Therape

10、utic plan,,,,Fundamental TX,Adjunctive TX,Reinforce TX,Default,LVAD/HTX,,Total Bililbin,Care/Hospice,Anti-Remodeling and Reverse Remodeling,Mancinid Ｄ & Burkhoff，Circulation, 2005,Acute Heart Failure,Chronic Heart Fa

11、ilure,,,,,,,,,,,,,,,,,,,,,,,Primary Endpoint (J-WIND),Ejection Fraction (EF) in Chronic Stage,Control,（,（,n=187,n=187,）,）,Nicorandil,（,（,n=190,n=190,）,）,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,p=0.460,p=0.460,36,36,40,40,

12、44,44,48,48,0,0,(%),(%),Control,（,（,n=199,n=199,）,）,ANP,（,（,n=155,n=155,）,）,36,36,40,40,44,44,48,48,0,0,(%),(%),p=0.024,p=0.024,左,左,室,室,駆,駆,出,出,率,率,hANP,,,Nicorandil,左,左,室,室,駆,駆,出,出,率,率,,43.2%,,42.5%,,44.7%,42.5%,The PRE

13、AMI Investigators, Arch Intern Med 2006,Anti-remodeling & Perindopril,In,Six Month’s BNP & CV Events,Nishii M et al: JACC 51(24):2329-35, 2008,,Six Month’s BNP & Reverse Remodeling,LVEF,,,at discharge,at 6

14、 months,P=0.005,,,,,at discharge,at 6 months,,,,LVDd,Nishii M et al: JACC 51(24):2329-35, 2008,Six Month’s BNP ＆Reverse Remodeling,Summary BNP guided therapy produces a superior and excellent outcome through physician

15、s’ awareness toward their proper treatment. However, the BNP measurement is not ‘a(chǎn)lmighty’ diagnostic tool leading to comprehensive CHF management.As a new check point, “anti-remodeling/reverse remodeling should be