戴闺柱---心力衰竭PPT.ppt

Statin therapy is associated with improved survival in ischemic and non-ischemic heart failure 100 80 60 40 20 0 100 80 60 40 20 0 0 4 8 12 0 4 8 12 P 0.001 No Statin Rx Months Statin Rx Statin Rx No Statin Rx P 0.001 Months Non-ischemic cardiomyopathy Ischemic cardiomyopatehy T B Horwich et al. J Am Coll Carded 2004;43:642-8 (N=298) (N=244) Effects of combined statin and beta-blocker treatment on one-year morbidity and mortality after acute myocardial infarction associated with heart failure 30 25 20 15 10 5 0 0 6 12 18 24 30 36 Month Neither (n=830) Beta-blocker only (n=2004) Statin only (n=496) Both (n=1971) Endpoint rate (%) A Hognestad et al. Am J Cardid 2004;93:603-6 Cardiac-Resynchronization therapy with or without implantable defibrillatior therapy in advanced chronic heart failure Hazard ratio for death any cause NO ACE inhibitor use ACE inhibitor use NO b-blocker use b-blocker use 0.0 0.5 1.0 1.5 2.0 2.5 Pacemaker-defibrillator better Pharmacologic therapy better Bristow MR, N Eng J Med 2004;350:2140-50 β - blocker no HR 0.72 ( 95%CI 0.51-1.02 ) β – blocker yes HR 0.59 ( 95%CI 0.46-0.76 ) CARE-HF 2005 ACC 现阶段: ACE-I + BB ± ARB or ALD antagonist 神经内分泌拮抗已达峰顶？ Are there limits？ 心肌细胞的丧失是心力衰竭 真正的基本原因 ? 衰竭心肌交感神经活性增加的致病作用, 主要通过β1受体介导 ? 当应用相等剂量的carvedilol 与 metoprolol 比较时,心肌的分子生物学效应,二者相似 ? 没有大型的心衰临床试验结果,支持α1阻滞或 抗氧化活性的效益 Dargie HJ. Beta blockers in heart failure. Lancet 2003 ; 362: 2-3 评 论 Conclusions ? The COMET trial demonstrates that --- when prescribed In the doses used in the study--- carvedilol is superior to immediate-release metoprolol in reducing the risk of death in patients with chronic heart failure. ? Physicians may choose between 2 options, 1. Switch to carvedilol 2. Prescribe a high dose of controlled-release