舒张性心力衰竭

書式設定,書式設定,第 2,第 3,第 4,第 5,*,Toranomon Hospital,第1回日中心血管,Clinical Aspects of Diastolic Heart Failure,Shin-ichi Momomura,MD,Cardiovascular Center,Toranomon Hospital,Tokyo,Japan,Incidence of Heart Failure Framingham Heart Study,J Am Coll Cardiol,1993;22:6A13A,Male,Female,Distribution of Left Ventricular Ejection Fraction:EuroHeart Failure Survey,European Heart Journal(2003),24,442463,What is Diastolic Heart Failure?,Diastolic(Heart)Failure,Heart failure due to diastolic dysfunction,Heart Failure with Preserved or NormalSystolic Function,Cf)Systolic Heart Failure,Causes of Diastolic Dysfunction,Left ventricular hypertrophy(common),Aortic stenosis,Chronic hypertension,Hypertrophic cardiomyopathy(with/wothout outflow tract obstruction),Acute episodic myocardial ischemica(common),Pericardial disease(rare),Tamponade,Constriction,Constrictive-effusive disease due to prior radiation therapy,Restrictive cardiomyopathy(rare),Amyloid disease,Idiopathic restrictive cardiomyopathy,Mechanism of DHF,LV diastolicdysfunction,CO,Neurohormnal activity,Exersional dyspnea,stroke volume,Sodium/water retension,LV filling pressure,edema,Pulmonary edema,Pulmonary congestionc,Acute elevation of BP,Epidemiology of DHF,Prevalence of DHF,Diagnostic,Criteria,Evaluation of LV function,Prevalence,Ghali,FHS,FS24%(UCG),28%,Taffet,FHS,EF45%(RNV),43%,Takarada,FHS,FS30%(UCG),24%,Vasan,FHS,EF50%(UCG),51%,Distribution of the severity of left ventricular systolicdysfunction by qualitative assessment,Women,Men,European Heart Journal(2003),24,442463,Prognosis of DHF and SHF(1),EF50%,EF50%,78,59,58,44,51,35,44,32,36,29,16,15,1.0,0.8,0.6,0.4,0.0,0,1,2,3,4,5,6,0.2,Expected,EF50%,EF50%,Survival,Years,Senni M.et al.：Circulation,98,2282,1998.,P=0.279,Prognosis of DHF and SHF(2),Smith GL.JACC 2003;41:1510-8,Characteristics:Demographic,Preserved EF,(n=200),Depressed EF,(n=213),p Value,Age,73,+,11,70,+,11,0.004,Male gender,74(37%),139(65%),0.001,White race,158(79%),159(75%),0.30,Smith GL.JACC 2003;41:1510-8,Characteristics:Cardiac History,Preserved EF,(n=200),Depressed EF,(n=213),p Value,EF,60,+,8,28,+,10,0.0001,HF,128(64%),169(79%),0.001,Previous.hospitalization for HF,60(30%),94(45%),0.002,Years of HF,2.4+5.4,3.3+5.5,0.002,Hypertension,160(80%),139(65%),0.001,Arrhythmia,77(39%),112(53%),0.004,Pacemaker placement,20(10%),40(19%),0.01,Smith GL.JACC 2003;41:1510-8,Characteristics:Cardiac History,Preserved EF,(n=200),Depressed EF,(n=213),p Value,Chronic stable angina,66(33%),91(43%),0.04,Myocardial infarction,78(39%),118(55%),0.001,Cardiac catheterization,75(38%),123(58%),0.001,CABG,39(20%),67(31%),0.006,PCI,19(10%),32(15%),0.09,Coronary artery disease,56(24%),176(76%),0.0001,Aortic stenosis,9(9%),14(9%),0.86,Smith GL.JACC 2003;41:1510-8,Characteristics:Non-cardiac History,Preserved EF,(n=200),Depressed EF,(n=213),p Value,Renal insufficiency,72(36%),74(35%),0.79,Respiratory disease,61(31%),56(26%),0.34,CVA/stroke,30(15%),33(15%),0.89,Diabetes,95(48%),102(48%),0.94,Smith GL.JACC 2003;41:1510-8,DHF in Japan,All,(n=172),Preserved Systolic Function,(n=61),Intermediate Systolic Function,(n=38),Depressed Systolic Function,(n=73),Age(yrs)(mean,+,SD),68,+,14,69,+,16,69,+,9,67,+,14,Men,105(61%),30(49%),23(61%),52(71%)*,Previous admission for CHF,60(35%),15(25%),13(34%),31(44%)*,Cause of CHF,Ischemic,75(44%),26(43%),16(42%),33(45%),Hypertensive,45(26%),20(33%),11(29%),14(19%),Cardiomyopathic,43(25%),7(12%),9(24%),27(37%),Tsutsui H et al.Am J Cardiol 2001;88:230-33,*p0.05,p0.01 vs.preserved systolic function values,DHF in Japan,All,(n=172),Preserved Systolic Function,(n=61),Intermediate Systolic Function,(n=38),Depressed Systolic Function,(n=73),Comorbidity,Myocardial infarction,61(36%),21(34%),10(26%),30(41%),Systemic hypertension,89(52%),40(66%),19(50%),30(41%),Diabetes mellitus,52(30%),18(30%),10(26%),30(41%),Chronic renal failure,22(13%),7(11%),8(21%),7(10%),LV hypertrophy,59(36%),31(51%),11(29%),17(23%),Atrial fibrillation,54(31%),18(30%),10(26%),26(36%),Smoking,46(27%),17(28%),10(26%),19(26%),Alcohol,41(24%),16(26%),8(21%),17(23%),Tsutsui H et al.Am J Cardiol 2001;88:230-33,p0.01 vs.preserved systolic function values,DHF in Japan,All,(n=172),Preserved Systolic Function,(n=61),Intermediate Systolic Function,(n=38),Depressed Systolic Function,(n=73),Digitalis,82(48%),24(39%),16(43%),42(58%)*,Diuretic,120(70%),37(61%),25(66%),58(80%)*,ACE inhibitor,101(59%),26(43%),20(53%),55(75%),Beta-blocker,40(23%),11(18%),13(34%),16(22%),Ca antagonist,64(37%),31(51%),12(32%),21(29%)*,Tsutsui H et al.Am J Cardiol 2001;88:230-33,p0.05,p0.01 vs.preserved systolic function values;,p40%,25th European Society of Cardiology Annual Congress(2003),CHARM,Added,CHARM,Preserved,CHARM,Alternative,CHARM:,Design,CHARM：Characeteristics,CHARM,Alternative,Added,Preserved,n,2,028,2,548,3,025,Age,67,64,67,Female(%),32,21,40,NYHA (%),48,24,61,NYHA (%),49,73,38,mean LVEF(%),30,28,54,Treatment,ACEIs,0,100,18,Diuretics,85,90,75,Digitalis,46,58,28,-blockers,54,55,56,Spironolactone,25,17,12,Eur J Heart Fai