舒張性心衰竭的最新觀念 - tma.org.tw

1 1 2 (heart failure with reduced ejection fraction, HFrEF) (heart failure with preserved ejection fraction, HFpEF) (remodeling) (hypertrophy) H F r E F (eccentric r e m o d e l i n g ) 3 (concentric r e m o d e l i n g ) H F p E F 4 H F r E F HFpEF (afterload) (acute decompensation) 5 6 HFrEF HFpEF OPTIMIZE-HF 7 HFpEF HFrEF HFpEF HFrEF HFpEF CHARM-Preserved8 I-PRESERVE9 PEP-C H F1 0 2013 57 1 43 (angiotensin receptor blocker, ARB) (angiotensin converting enzyme inhibitor, ACEI) HFpEF H F r E F H F p E F ( e n d -systolic elastance, Ees)

2 11 HFrEF HFpEF HFrEF H F p E F 1 2 (matrix metalloproteinase, MMP) 13 (LVEF) LVEF 14 LVEF 15 LVEF 16 (transmitral inflow pulsed-w a v e D o p p l e r ) (active relaxation) ( s t i ff n e s s ) (relative wall thickness) ( l o a d -d e p e n d e n t ) tissue Doppler imaging, TDI TDI 17 (strain) - ( s p e c k l e t r a c k i n g echocardiography, STE) (strain) (strain rate) TDI 18 TDI STE 2013 57 1 44 T D I To r r e n t - G u a s p (muscle band theory)19 2 0 (longitudinal)

3 (circumferential) (radial) - HFrEF HFpEF HFpEF HFrEF HFpEF HFrEF HFpEF 1. Roger VL, Weston SA, Redfield MM, et al: Trends in heart failure incidence and survival in a community-based population. JAMA 2004; 292: Paulus WJ, Tschope C, Sanderson JE, et al: How to diagnose diastolic heart failure : a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007; 28: 2539 Jessup M, Abraham WT, Casey DE, et al: 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College o f C a r d i o l o g y F o u n d a t i o n / A m e r i c a n H e a r t Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.

4 Circulation. 2009; 119: 1977 Z i l e M R , G o t t d i e n e r J S , H e t z e l S J , e t a l ; I-PRESERVE Investigators. Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation. 2011; 124: Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 2001; 344: 17 Haider AW, Larson MG, Franklin SS, et al: Systolic blood pressure, diastolic blood pressure, 2013 57 1 45and pulse pressure as predictors of risk for congestive heart failure in the Framingham Heart Study. Ann Intern Med. 2003; 138: 10 Fonarow GC, Stough WG, Abraham WT, et al: Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure : a report from the OPTIMIZE-HF Registry.

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7 I. The normal macroscopic structure of the heart. Semin Thorac Cardiovasc Surg 2001; 13: 301-20. Sosnovik DE, Baldwin SL, Lewis SH, et al: Transmural variation of myocardial attenuation measured with a clinical imager. Ultrasound Med Biol 2001; 27: 1643 50. 2013 57 1 46