心力衰竭管理发展历程.ppt

Gene Therapy Major challenges Development of an ideal vector (e.g. adenovirus) A method of delivery of these vectors Identification of appropriate gene targets, e.g. cardiac S100A1, a calcium binding gene, and sarcoplasmic reticular Ca2+ gene Mechanical assistance Cardiac transplantation will always be limited the availability of donor hearts Ventricular assist devices (VADs) Mainly used as bridges to transplantation As destination therapy? REMATCH trial: encouraging but the device was too large with many complications Ventricular assist devices (VADs) Current effort Reduce the incidence of complications and size of the device Indications for VADs are expected to expand quickly in the next five years to provide destination therapy Conclusions The field of HF study is now at a historic juncture The pandemic of HF is increasing rapidly because of the aging population and increased number of survival patients following MI Studies on prevention and management of HF is accelerating Conclusions (continued) Advances in genetics, cell biology and molecular pharmacology will enhance understanding of the causes of HF Currently used ACEI, beta-blockers and CRT have clear benefits to clinical outcomes of HF Development in bioengineering could have an enormous beneficial impact on both incidence and management Chronic heart failure (CHF) Definition a complex clinical syndrome with typical clinical symptoms that can occur at rest or on effort, and is characterised by objective evidence of an underlying structural abnormality or cardiac dysfunction that impairs the ventricle to fill with or eject blood The term congestive heart failure is no longer used. MADIT-II Moss AJ. N Engl J Med. 2002;346:877-83. Defibrillator Conventional P = 0.007 1.0 0.9 0.8 0.7 0.6 0.0 Probability of Survival 0 1 2 3 4 Year No. At Risk Defibrillator 742 502 (0.91) 274 (0.94) 110 (0.78) 9 Conventional 490 329 (0.90) 170 (0.78) 65 (0.69) 3 Non-pharmacological Physical activity tailored to individua