2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 7 :,, 430022,,,5 50, 20 %, 40 %, ( ),,,,,,, (self2perpetuating), :,, : (),,,, (Ang ),,,,,,, :,,,,, (ACE) 2,,,,, (LVEF),,, 10, /,,,,,, [ ACTION2HF : (1999) ; : (1997,2001) ] LVEF,, NYHA, 5,,,,, camp,,,,,
8 2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11, () : (1) LVEF 40 %(2) (3) ( ) 11,, 21 (2DE) : (1) (2),,,,,, LVEF, (LVEDV) (LVESV) (3),LVEF 40 % LVEF (4)LVEF LVESV (LVESVI = LVESV/ ) 45 ml/ m 2, 3 (5) 1/ 2, M, LVEF,,M,2DE Simpson LVEF2DE, LVEF,,, 2DE,,2DE 31 : LVEF, 41X:, 51 :,, 61 :,,, 71 : (1) (DSE) (2) ( 201 Tl 99 Tc m 2MIBI SPECT) ( FDG) (PET), 80 %85 %, 85 %, 201 Tl 99 Tc m 2MIBI 90 %,70 %PET,,, 81 :, () 11 NYHA : : : ( ) : : LVEF 21 6 min :, 6 min,, 6 min, SOLVD (Studies Of Left Ventricular Dysfunction),6 min,8, 10123 %, 2199 % ( P = 0101) ;,22116 %,
2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 9 1199 %( P < 01000 1), 6 min (),, (, ),,,, (), 24 h () 11, NYHA 21 6 min, () 11 :,,,,,,, Infarction Ramipril Efficacy study ) TRACE 21 : (1) (2) (3) (NYHA ), ACE (4) (5),,, 4 (Scandinavian Simvastatin Survival Study),,30 %, S 20 % ( P = 01015) NYHA, SHEP (Systolic Hypertension in the Elderly Program), 30 %, 49 %( P < 01001),,81 % ( P = 01002) HOPE ( Heart Outcomes Prevention Evaluation study),, 22 % ; 16 %, A,,,,, (ACE 2),, ACE 2,,, ACE,SAVE ( Survival And Ventricular Enlargement study) AIRE (Acute (Trandolapril Cardiac Evaluation), 19 % 27 %22 % ; 22 % 23 %29 %SOLVD(Studies Of Left Ventricular Dysfunction),, LVEF 35 %, 20 %
10 2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11,,,, ; ;,,,,,,,,, 3 5 min ;,,,, 3 5, 2030 min,,, : (1) AR, Q 10 1,6,,,,,, () : (NYHA ),,,,,,ACE 2,,,, ACE,,, 2,, 2 ACE (AR),, (2),,, (3) AR,,,, (4), (MR), LVEF,,, MR MR,,,,,,
2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 11 Henle, (furosemide),,, (spironolactone) ( triamterene) (amiloride),, 20 %25 %, (< 5 ml/ min),, 5 %10 %,,,(< 30 ml/ min), (),,,,,,,,,,, : (1),, ;, ACE 2 (2),ACE, ACE (3), ACE ; 2,, ACE ACE Ang, () :,, NYHA,,, ACE 2 :, 20 mg ; 25 mg,, 015110 kg, (,, ),,, 31 :,, 100 mg/ d ( 2),,,, 41 :,,,,,,,,,,,, : (1) : (15 mg/ h) (2) 2 2 (3) : (25g kg - 1 min - 1 ),,
12 2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11, () : 22 ACE,,, RALES ( Randomized Aldactone Evaluation Study), (25 mg/ d) :,,,,,,, g,, NYHA g,, ACE 2 g,,, g( 25 mg/ d, 20mg/ d),100 mg/ d, g (,, ), ACE,, g,, g,,, ACE 2,,,ACE, ACE Ang,, g, :,,,, 2,, (RAS) Ang,, ; g (),, : (1), (15 mg/ d),ace (2) 2 2 (3) 2, (25g kg - 1 min - 1 ) ACE ACE 2 : (1) RAS(2),, ACE RAS, RAS,RAS RAS,Ang ;, RAS, RAS ;, ACE, mrna,ang Ang DNA, RAS
2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 13 ACE Ang,ACE, Ang II,,ACE ACE, Ang,ACE,,ACE,ACE () SOLVD(Studies Of Left Ventricular Dysfunction) 2 569, (NYHA ), 41 16 %( ) ( P = 01003 6), 26 % ( P < 01000 1) V2HeFT (Veterans Heart Failure Trial II) 804 (NYHA ) ( 20 mg/ d) (300 mg/ d) (160 mg/ d), 215,28 % ( P = 01016) CONSENSUS ( Cooperative North Scandinavian Enalapril Survival Study) 253 (NYHA ) 6, 27 %( P = 01003), 39 ACE (8 308,1 361 ),,LVEF < 45 %, ACE,,,, 24 %(95 %13 %33 %) ACE,, ACE () 11 : (1) (LVEF < 40 %), ACE, ; (NYHA ), ;(2) ( ),,, :,,ACE ACE, 21 ACE :ACE, ACE : (1) (2) [ > 22512 mol/ L ( 3mg/ dl) ] (3) ( > 515 mmol/ L) (4) ( < 90 mm Hg),, ACE 31 : (1) : ACE ;ACE ACE,, ( 1) 37 d 1, ACE 90 %(2) :,ACE,,,, (Assessment of Treatment with Lisinopril and Survival, ATLAS) (321535 mg/ d) (215510 mg/ d), (3) :, ACE
14 2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 12,,,ACE,(4) ACE :,ACE, ACE ACE ACE,, ACE 1 ACE 6125 mg,3 / d 2550 mg, 3 / d 215 mg,1 / d 10 mg,2 / d 2 mg,1 / d 4 mg,1 / d 1125215 mg,1 / d 2155 mg,2 / d 215 mg,1 / d 510 mg,2 / d 10 mg,1 / d 2040 mg,1 / d 015 mg,1 / d 1215 mg,1 / d 215 mg,1 / d 520 mg,1 / d : () ACE : (1) Ang : ; (2), :, RAS,, ( < 130 mmol/ L) : (1) (2) ACE 12 d, RAS gace,,,, RAS ACE : Ang,NYHA ACE [ > 442 mol/ L (015 mg/ dl) ],, ACE,, ACE 1,, > 22512 mol/ L (3 mg/ dl) ACE :ACE,,, ACE 1, 515 mmol/ L,ACE :ACE,,,, ACE, ACE,,, Ang : ( < 1 %),,, 24 h,, ACE,ACE ACE,NYHA 2,,LVEF < 45 %, g : (1),, (2), gace gace,, ACE 2 () gace :ACE,
2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 15, ACE : (1) (2) [ > 22512mol/ L (3 mg/ dl) ] (3) ( > 515 mmol/ L) (4) (< 90 mm Hg) :, ACE gace :, 37 d, 1 2, ATLAS, ACE,,,,,NE 1 2,NE 2 DNA 1 2 G s,,,gs 2 2, 2, 1 2 2 1 2 2 1 2,, 1 2 1 2, (bucindolol) () 11 : MERIT2HF ( Metoprolol CR/ XL Randonmised Intervention Trial in Heart Failure) 3 991 NYHA, 18 34 % ( P = 01006), 38 % ( P = 01000 03),49 % ( P = 01002 3), 41 % ( P = 01000 2),795 LVEF < 25 %( 19 %),NYHA, ( n = 399) ( n = 396) 1117 %1911 %, 39 % ( P = 01008 6), 45 % ( P = 01024) 21 : CIBIS ( Cardiac Insufficiency Bisoprolol Study ) 2 647 (NYHA ), 10 mg/ d, 16 34 % ( P < 01000 4), 20 % ( P = 01000 6), 36 %( P < 01000 1), 44 %( P = 01001), 2 31 :US,1 094 (NE) 3 4,,NE,( ), 718 %( n = 31), 312 % ( n = 22), 65 % ( P = 01000 1) ( ), COPERNICUS ( Carvedilol Prospective Randomised Cumulative Survival trial ) 2 289,LVEF < 25 % ( 1918 %), 1014, 1917 %, 35 % ( P = 01001 4) 41 :BEST (Beta2blocker Evaluation Survival Trial) 2 708 NYHA,NYHA ( 92 %) 10 %, ( P = 0113) 14 % ( P = 0104), 22 % ( P < 01001) 51 :, 20, 10 000 2 (LVEF < 45 %),NYHA,,, ACE 2,39 ACE (8 308 1 361 ),
16 2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 24 %(95 %CI 13 %33 %), 2 ACE, 36 % (95 %CI 25 %45 %), () 11 : NYHA,LVEF < 40 %, 2, 2,, 2, ACE 2, NYHA, 2NYHA,,,,,, 2,,( 3 ),LVEF, 2,, 2,, : (1) 2 3 (2), 2 (3), 2. : ( < 60 / min) ( ) 31 : (1), 1215 mg 1, 1125 mg 1, 31125 mg 2,24,,, 2 2 85 %90 %(2),,, ;, (3) : 2,ACE,,,,,,,,,, 2,,,< 55 / min,, 2,,ACE,, 2,, 2, 2(4) : : 2 2448 h, ACE 2, ACE,,, : 35 d,,12,,,,, : 2,, < 55 / min, 2, 41 2 :, 1 2 1 2,,,,, : 1 2
2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 17 1 2 2 g,nyha,lvef < 40 %,, 2, g: (1) 23,, (2), g 2, gnyha, (4 d ;), g ACE 2 2 g g ( < 60 / min) g( ) g,, 2 g,, g 2 ( 1215 mg/ d 1125 mg/ d 31125 mg, 2 / d) 24 g, 2 g: 2, 2448 h ACE 2, g: 35 d,,12,, g: 2,< 55 / min,, 2 Na + / K + 2ATP, Na +, Na + 2Ca 2 +,Ca 2 +,,, Na + / K + 2ATP Na + / K + 2ATP,,,, Na + / K + 2ATP,,,,,, 200,, (FDA), (), 13,,, ACE PROVED ( Prospective Randomized Study Of Ventricular Failure and the Efficacy of Digoxin),12,, 39 % 19 %RADIANCE ( Randomized Assessment of Digoxin on Inhibitors of the Angiotensin2 Converting Enzyme), ACE ACE,25 %5 %, 1997 DIG(Digitalis Investigation Group trial), 6 801, LVEF 28 %, NYHA 50 %, 2 % (ACE ),
18 2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 0125 mg/ d (70 % ), 015 mg/ d, 2858 ( 37 ),,315, 30 % ( P = 0180), ( P = 0106) (, ) (28 %, P 01001), 6 %, (LVEF < 25 %,NYHA, > 0155),12 % 8 %,2 %,,,, ;,, () 1. :,, (ACE 2),, 2. :, ACE 2ACE 2,, ACE 2,,, ACE 2 2, ( 2),,,, ( ), (NYHA I ),, 3. :,, 01125 0125 mg/ d ; 70, (01125 mg) 1 1,, (013750150 mg/ d),, 2,,,, 4. : : (1) ( ) (2) () (3) ( ) > 210 ng/ ml,,,,,,,,, ( )
2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 19, ( < 210 ng/ ml),,, g, ACE 2, 2 g, NYHA I g0125 mg/ d70, 01125 mg,1 1 1 g, g,, g,,, 2 (ALD), ALD ALD ALD, ;,ALD Ang Ang,ALD,ALD mrna, ALD ACE ACE Ang II,, Ang 1 Ang,ALD,, ACE, ALD,,ALD, (ALD escape), ACE,ALD,ACE ALD,, 20 %, ;ALD ACE ALD, Ang ALD ACE, ALD, () RALES(Randomized Aldactone Evaluation Study),1 663 ( NYHA ), ( 25 mg/ d), 24, 27 %, 36 %, 22 % ( P < 01000 2),, 8 % 9 % () :NYHA, 20 mg/ d Ang II 20 ACE,,,Ang I Ang II,Ang 1, RAS ACE,,, ACE,Ang (ARB) ACE ARB Ang II Ang 2, ARB,,
20 2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 ARB ACE, () 1997 ARB ELITE( Evaluation of Losartan In The Elderly), 722 NYHA IIIV, LVEF 40 %, 65, (50 mg/ d) (150 mg/ d), ELITE II( Evaluation of Losartan In The Elderly ),3 052 > 60,, 2000 AHA Val2HeFT,( ACE 2 ), 5 010, 40 mg 2 160 mg 2, 2,ACE 93 %, 2 36 %, 1313 %( P = 01009),2715 %( P = 01000 01), ARB () 11ARB, ACE, ARB ACE ACE ACE, ACE 21ARB ACE,,ARB ACE,,, 31 2, ACE ARB garb, ACE g ACE ACE ARB gace garb ACE,, g 2,ARB ACE,,,,,, (),,, ( ) 2 : PRAISE ( Prospective Randomized Amlodipine Survival Evaluation), (NYHA B/ ) 1 153, (10 mg/ d) 633 ( 1318 ) ( ),( P = 0107)
2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 21 PRAISE, 45 %( P = 01001), PRAISE, V2HeFT ( Vasodilator2Heart Failure Trial ), 450,, (10 mg/ d) 339 ( 18 ), (),,,, (),,,, g, g,,,, (camp) : (1) 2 : ; (2), camp,,,, ( ), PROMISE ( Prospective Randomized Milrinone Survival Evaluation trial) Ibopamine PRIME ( Second Prospective Randomized Study of Ibopamine on Mortality and Efficacy), 1 088 1 906 NYHA,,, (),,,, 2 > 1,,,, FDA camp,, 35 d: 25 g kg - 1 min - 1 ; : 50 g/ kg, 0137501750g kg - 1 min - 1 camp g,, g 35 d g :25g kg - 1 min - 1 ;: 50g/ kg, 0137501750g kg - 1 min - 1,,,
22 2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11, 11 ( ) :, 16 %,,,,,,,: (1),,(2),,,, (), 2,, 23 (3), 21,,,,, 31 : :,,, : 2,, :, d2sotalol dofetilide GESICA ( Grupo de Edtudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina),516, 2, 28 %( P = 01024), 31 % ( P = 01002 4) CHF STAT ( Congestive Heart Failure : Survival Trial of Antiarrhythmic Therapy),674,45, ( P = 0160), ( P = 0107 0108), LVEF d2sotalol dofetilide [ SWORD ( Survival With Oral d2sotalol ) DIAMOND ( Danish Investigations of Arrhythmia Mortality On Dofetilide) ],,,, 012 g 3, 5 7 d ; 012 g 2,57 d ;012 g 1 012 g 2, 5 d,012 g 1 41,,, 51, 61 :,,,,,,,,,,, ;,
2002 1 30 1 Chin J Cardiol, January 2002, Vol1 30 No11 23 g g,, g, g, g,,, ACE 2 g,,,, ;,,, cheyne2stokes, gnyha : ; ACE gnyha :ACE ; ; 2 ; gnyha : ACE ;; 2 ; gnyha : ACE ;; ; ;, 2,,,, 1 %3 %, : 11,, 23 21 LVEF,, 31, : :,,,, ( :2001210216) ( :)