课件：心力衰竭辅助检查.ppt

创伤性血流动力学检查 应用漂浮导管可测定肺毛细血管楔嵌压(PCWP)和心排血量(CO)、心脏指数(CⅠ)。 PCWP 可反映左室舒张末期压。PCWP 正常值为0.8～1.6kPa(6～12mmHg) PCWP 升高程度与肺淤血呈正相关: 当PCWP＞2.4kPa(18mmHg)时即出现肺淤血； 3.3kPa(25mmHg)时，有重度肺淤血； 4kPa(30mmHg)时，即出现肺水肿。 CⅠ正常值为2.6～4.0L/(min/m2)当CⅠ＜2.2L/(min/m2)时 即出现低排血量症状群。 冠状动脉造影 适用于有心绞痛或MI需血管重建，或临床怀疑CHD的患者； 可鉴别缺血性或非缺血性心肌。 有心肌存活的患者，血管重建可有效改善左室功能。 心肌活检 对不明原因的心肌病诊断价值有限，但有助于明确心肌炎症性或浸润性病变的诊断 Thanks THANK YOU SUCCESS * * 可编辑 * * * * * * * * * * While the use of BNP for screening in the general population is not currently warranted, targeted screening of individuals at high risk of developing left ventricular systolic dysfunction would lead to more economical use of more expensive cardiac imaging procedures such as echocardiography or ultrasound. Many studies have shown that fewer than 30% of symptomatic patients referred for echocardiography turned out to have heart failure. A reliable rule-out test for CHF, with an Negative Predicative Value (NPV) of 98% or better, when used on the above population could eliminate unnecessary testing in ~68% of the symptomatic population. Additionally, a number of other utilities can be envisioned wherein BNP could be used to predict outcome, progression or response to therapy of disorders characterized by impaired cardiac function. BNP is a very active research topic today. There is no doubt that future studies will focus much time on these other potential uses of BNP. BNP has also been shown to be a useful prognostic indicator. BNP values increase as CHF progresses in severity. Increasing BNP values also correlate with the NYHA Classes and left ventricular ejection fraction. These are discussed in greater detail in slides 9-11. Since BNP appears to be the most powerful neurohormonal predictor of left ventricular function, a new area of clinical research is supporting the use of BNP in selecting patients for specific drug therapy. Studies are also being conducted to provide gui