2012ESC急慢性心衰指南解读课件.ppt

2012 ESC关于急慢性心力衰竭诊断及治疗指南解读

Table A 推荐级别
Classes of
mendations
Definition
Suggested wording to use
Class I
Evidence and/or general agreement
that a given treatment or procedure
is beneficial, useful, effective.
Is mended/is
indicated
Class II
Conflicting evidence and/or a
divergence of opinion about the
usefulness/efficacy of the given treatment or procedure.
Class IIa
Weight of evidence/opinion is in
favour of usefulness/efficacy
Should be considered
Class IIb
Usefulness/efficacy is less well
established by evidence/opinion.
May be considered
Class III
Evidence or general agreement that
the given treatment or procedure
is not useful/effective, and in some
cases may be harmful.
Is not mended
Table B 证据水平
Level of
evidence A
Data derived from multiple randomized
clinical trials or meta-analyses.
Level of
evidence B
Data derived from a single randomized
clinical trial or large non-randomized
studies.
Level of
evidence C
Consensus of opinion of the experts and/
or small studies, retrospective studies,
registries.

与2008年的指南比较,此次指南的主要改变涉及以下几点:
(i) 扩大了盐皮质激素受体拮抗剂(MRAs)的适应症(醛固酮);
(ii) 窦房结抑制剂伊伐布雷定(ivabradine)新的适应症;
(iii) 扩大了CRT的适应症;
(iv) 关于心衰患者冠状动脉重建术作用新的信息;
(v) 认识心室辅助设备日益增长的作用;
(vi) TAVI(transcatheter valve interventions)的展现。

心力衰竭的定义
Heart failure can be defined as an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a mensurate with the requirements of the metabolizing tissues, despite normal filling pressures (or only at the expense of increased filling pressures)。
临床上心衰被定义为一种综合征,该综合征包含由于心脏结构及功能异常导致的典型的症状(如:气紧、踝部肿胀、疲劳)及典型的体征(如:颈静脉压升高、肺部湿啰音、心尖搏动移位)
心衰的很多症状不具有鉴别性,因此诊断价值有限。并且心衰患者很多体征是由于水钠潴留引起的,经过利尿治疗后这些体征可以消失,也就是说,心衰患者可以不出现典型体征。上述情况可以造成心衰诊断困难。因此论证导致心衰的病因是诊断心衰的核心。
与左心室射血分数相关的术语
EF:每搏输出量(即:心舒张末期容积减去收缩末期容积) 除以心舒张末期容积(百分比);
EF越低,存活越差;
很多相关临床试验基于EF选择患者;