248 Chinese Circulation Journal August 2002 Vol117 No14 (Serial No1116) Ξ (LV EF) 5 50 10 20 % 40 % / ( ) [ (self2perpetuating) ACTION2HF : (1999) ; : (1997 2001) ] : LV EF : ( N YHA ) 5 (Ang ) camp : ( ) : (1) (ACE) 2 LV EF 40 % (2) Ξ : 430022
2002 8 17 4 ( 116 ) 249 (3) ( DSE) ( 2 ) ( 201 Tl ( ) 99m Tc2M IB I SPECT) 11 ( FD G) ( PET) 80 % 85 % 85 % 21 ( 2DE) : (1) (2) 201 Tl 99m Tc2M IB I LV EF (LV EDV) 90 % 70 % PET (LV ESV) (3) LV EF 40 % LV EF ( 4) 81 : LV EF LV ESV (LV ESV I = LV ESV/ ( ) ) 45ml/ m 2 3 11N YHA : : (5) : ( 1/ ) : 2 M : LV EF LV EF M 216 min : 2DE Simpson 6 min LV EF 2DE LV EF 6 min 2DE SOL VD ( St udies Of Left Vent ricular Dysfunction) 6 min 8 2DE 10123 % 2199 %( P = 0101) ; 31 : 22116 % 1199 % ( P < LV EF 010001) 6 min ( ) 41X : ( ) 51 : 61 : ( ) 24 h 71 : (1)
250 Chinese Circulation Journal August 2002 Vol117 No14 (Serial No1116) ( ) 11 N YHA 216 min ACE SAV E ( Survival And ( ) Ventricular Enlargement study) AIRE (Acute In2 11 : farction Ramipril Efficacy study) TRACE ( Tran2 dolapril Cardiac Evaluation) ACE 19 % 27 % 22 % ; 22 % 23 % 29 % SOLVD ( Studies Of Left Ventricular Dysfunc2 tion) LV EF 21 : (1) 35 % (2) (3) ( N YHA ) (4) 20 % (5) N YHA 4 S ( Scandinavian Sim2 vastatin Survival Study) 30 % 20 % ( P = 01015) SHEP ( Systolic Hyperten2 sion in the Elderly Program) 30 % 49 % ( P < 01001) ; ; 81 % ( P = 01002) HOPE ( Heart Out2 comes Prevention Evaluation study) 22 % ; 16 % A 3 5 min ; 3 5 20 30 min (ACE 2 ) ACE 2
2002 8 17 4 ( 116 ) 251 (MR) LV EF Q 10 1 6 MR MR ( ) Henle (furosemide) ( spironolactone ) ( tri2 amterene) (amiloride) : (N YHA ) 20 % 25 % ( < 5 ml/ min) ACE 5 % 10 % 2 ( < 30 ml/ min) ( ) ACE 2 2 ACE (AR) : (1) : AR (1) (2) ; ACE 2 (3) AR (2) (4) ACE
252 Chinese Circulation Journal August 2002 Vol117 No14 (Serial No1116) ( 2 5 ACE g kg - 1 min - 1 ) (3) ACE ; 2 ( ) ACE 11 : ACE Ang 2 2 ACE ( ) RAL ES ( Randomized Aldactone Evaluation Study) (25 mg/ d) ACE 11 : N YHA ACE 2 21 : 20 mg ; 25 mg 015 110 kg 21 : ( ) 2 ( RAS) Ang ; ACE 2 31 : 31 : 100 mg/ d ( 2 ) 41 : g N YHA : (1) : (1 5 mg/ h) (2) 2 2 g (3) :
2002 8 17 4 ( 116 ) 253 ACE 2 g ACE Ang ACE g ( 25 mg/ d ACE Ang 20 mg/ d) 100 mg/ d ACE g ( ACE ) ACE ( ) g SOLVD(Studies Of Left Ventricular Dysfunction) 2 569 g (N YHA ) 41 ACE 2 16 %( ) ( P = 01003 6) 26 %( P < 01000 1) V2HeFT (Vet2 ACE ACE erans Heart Failure Trial ) 804 Ang (N YHA g ) ( 20 mg/ d) (300 mg/ d) (160 mg/ d) 215 28 % ( P = 01016) CONSENSU S ( Cooperative Nort h Scandinavian Enalapril Survival Study) 253 g ( ) (N YHA ) : (1) 6 (1 5 mg/ d) (2) 2 2 27 %( P = 01003) (3) 39 ACE (2 5 g kg - 1 min - 1 ) (8 308 1 361 ) ACE LV EF < 45 % ACE ACE 2 : (1) RAS (2) 24 % (95 % ACE RAS 13 % 33 %) ACE RAS ACE RAS Ang ; RAS RAS ( ) ; ACE 11 : (1) (LV EF mrna Ang < 40 %) ACE Ang ; (N YHA DNA RAS ) ; (2) ACE Ang ( )
254 Chinese Circulation Journal August 2002 Vol117 No14 (Serial No1116) 1 ACE : 6125 mg 3 / d 25 50 mg 3 / d ACE 215 mg 1 / d 10 mg 2 / d ACE 2 mg 1 / d 4 mg 1 / d 1125 215 mg 1 / d 215 5 mg 2 / d 21 ACE : ACE 215 mg 1 / d 5 10 mg 2 / d 10 mg 1 / d 20 40 mg 1 / d 015 mg 1 / d 1 215 mg 1 / d ACE 215 mg 1 / d 5 20 mg 1 / d : (1) (2) : [ > 22512 mol/ L (3mg/ dl) ] (3) ( > 515 mmol/ L) (4) ( < 90 ( ) mmhg) ACE : (1) Ang ACE : 31 : (1) : ; (2) ACE ; ACE 11 : ACE RAS ( 1) ( < 3 7 d 1 130 mmol/ L) : (1) (2) 1 2 d RAS ACE 90 % (2) : ACE RAS ACE 21 : (Assessment of Treat ment wit h Lisinopril and Ang Survival A TLAS) (3215 35 mg/ d) N YHA (215 ACE [ > 442 mol/ L 510 mg/ d) (015 mg/ dl) ] (3) : ACE 1 2 ACE ACE ACE 1 (4) > 22512 mol/ L (3 mg/ dl) ACE : ACE ACE ACE 31 :ACE ACE ACE ACE ACE 1 515 mmol/ L ACE
2002 8 17 4 ( 116 ) 255 41 :ACE 2 (N E) ACE N E ACE Ang N E 1 2 N E 2 DNA 51 : ( < 1 %) 1 2 Gas 24 h Gs 2 2 ACE ACE 2 ACE N YHA 1 2 2 2 1 2 ACE 2 g ACE 1 2 1 2 LV EF < 45 % 1 2 (bucindolol) g : (1) ( ) 11 : MERIT2HF ( Metoprolol CR/ XL (2) Randonmised Intervention Trial in Heart Failure) gace 3 991 N YHA gace ACE 18 2 ( ) 34 % ( P = 01006) gace : ACE 38 %( P = 01000 03) 49 %( P = 01002 3) ACE 41 % ( P = 01000 2) 795 : (1) (2) LV EF < 25 %( 19 %) N YHA [ > 22512 mol/ L (3 mg/ dl) ] (3) ( n = 399) ( > 515 mmol/ L) (4) ( < 90 ( n = 396 ) 1117 % mmhg) : 1911 % 39 % ( P = 01008 6) ACE 45 %( P = 01024) gace : 21 :CIB IS ( Gardiac Insufficiency Biso2 3 7 d prolol Study ) 2 647 ( N YHA 1 2 ) 10 mg/ d 16 ATLAS 34 %( P < 01000 4) ACE 20 %( P = 01000 6) 36 %( P < 01000 1) 44 % ( P = 01001) 31 :US
256 Chinese Circulation Journal August 2002 Vol117 No14 (Serial No1116) 1 094 3 4 2 ( ) ( 3 ) 718 % ( n = LV EF 2 31) 312 %( n = 22) 65 % ( P = 01000 1) ( ) COPERN ICUS ( Carvedilol Prospective Randomised Cumulative Sur2 vival trial) 2 289 2 LV EF < 25 % ( 1918 %) 1014 1917 % 35 % ( P = : (1) 2 3 01001 4) (2) 2 41 :BEST (Beta2blocker Evaluation Survival Trial) 2 708 N YHA N YHA ( 92 %) 21 : ( < 10 % ( P = 60 / min) ( 0113) 14 %( P = 0104) ) 22 % ( P < 01001) 31 : (1) 1215 mg 1 1125 mg 51 : 20 1 31125 mg 2 10 000 2 2 4 ( LV EF < 45 %) N YHA 2 2 ACE 85 % 90 % (2) 2 39 ACE (8 308 ; 1 361 ) 24 %(95 % (3) CI 13 % 33 %) 2 ACE : 2 36 % ( 95 % CI 25 % 45 %) ( ) (3) ACE 11 : N YHA LV EF < 40 % 2 2 2 2 < 55 / min ACE 2 2 N YHA 2 N YHA ACE 2
2002 8 17 4 ( 116 ) 257 g ( < 60 / min) 2 g ( 2 (4) ) : : 2 g 24 48 h 2 ACE 2 g ACE g 2 ( : 1215 mg/ d 1215 mg/ d 31125 3 5 d 1 2 mg 2 / d) 2 4 g : 2 2 g : 2 < 55 / min 24 48 h 2 ACE 2 41 2 : g : 3 5 1 2 1 2 d 1 2 g : 2 : 1 2 < 55 / min 1 2 2 2 Na + / K + 2 g N YHA A TP Na + Na + 2Ca 2 + LV EF < 40 % 2 Ca 2 + g : (1) 2 3 Na + / K + 2A TP (2) Na + / K + 2A TP g 2 Na + / K + 2A TP gn YHA (4 d ; ) g ACE 2 2 g 200
258 Chinese Circulation Journal August 2002 Vol117 No14 (Serial No1116) ( FDA) ( ) ( ) 1 3 11 : ACE PROV ED ( Prospective Randomized (ACE 2 ) Study Of Ventricular Failure and the Efficacy of Digox2 in) 12 21 : 39 % ACE 19 % RADIANCE ( Randomized Assessment of Digox2 2 ACE in on Inhibitors of t he Angiotensin2Converting Enzyme) 2 ACE ACE 2 ACE 25 % 5 % ACE 2 2 1997 D I G(Digitalis Investigation Group trial) 6 801 ( 2 ) LV EF 28 % N YHA 50 % 2 % (ACE ) 0125 mg/ d (70 % ) 015 mg/ d 28 58 ( ) ( 37 ) 315 30 %( P = 0180) (N YHA ) ( P = 0106) ( ) (28 % P 01001) 6 % 01125 0125 mg/ d ; 70 (LV EF < 25 % N YHA (01125 mg) 1 1 > 0155) (01375 0150 mg/ d) 12 % 8 % 2 % 2 31 : ;
2002 8 17 4 ( 116 ) 259 41 : 2 : (1) ( (ALD) ) (2) ( ) (3) ALD ( ) ALD ALD > 210 ng/ ml ; ALD Ang Ang ALD ALD mrna ALD ALD ACE ( ) ALD ALD (ALD es2 ( < 210 cape) ACE ALD ng/ ml) ACE ALD 20 % ; ALD ACE ALD g ACE 2 ( ) RAL ES( Randomized Aldactone Evaluation St udy) 2 1 663 ( N YHA g ) N YHA ( 25 mg/ d) 24 01125 mg 1 1 1 g 8 % 9 % g ( ) : N YHA ALD Ang ALD ACE 27 % g 0125 mg/ d 70 36 % 22 %( P < 01000 2) 20 g mg/ d
260 Chinese Circulation Journal August 2002 Vol117 No14 (Serial No1116) Ang 20 ACE 11 ARB ACE ARB ACE Ang ACE ACE Ang Ang 1 ACE RAS ACE 21 ARB ACE ARB ACE ACE Ang (ARB) ACE ACE Ang Ang 1 31 2 Ang ACE ACE ARB Ang Ang 2 ARB ARB garb ACE g ACE ACE ARB ARB ACE ( ) 1997 ARB EL ITE( Evaluation of Losartan In The Elderly) g 2 722 N YHA LV EF ARB ACE 40 % 65 ( 50 mg/ d) ( 150 mg/ d) EL ITE ( 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 ( ) g ACE garb ACE
2002 8 17 4 ( 116 ) 261 (camp) : (1) 2 ( : ; (2) ) 2 : PRAISE ( Prospective Randomized Amlodipine Survival Evaluation) (N YHA B/ ) 1 153 ( (10 mg/ d) 6 33 ( ) 1318 ) ( PROM ISE( Prospective Randomized ) Milrinone Survival Evaluation trial) Ibopa2 ( P = 0107) mine PRIME ( Second Prospective Randomized Study of Ibopamine on Mortality and Efficacy) PRAISE 1 088 1 906 N YHA 45 % ( P = 01001) PRAISE V2HeFT (Vasodilator2 Heart Failure Trial ) 450 ( ) (10 mg/ d) 3 39 ( 18 ) 2 > 1 ( ) FDA ( ) camp 3 5 d : 2 5 g kg - 1 min - 1 ; :50 camp g/ kg 01375 01750 g kg - 1 min - 1 g camp g g g
262 Chinese Circulation Journal August 2002 Vol117 No14 (Serial No1116) 3 5 d kg - 1 min - 1 g : 2 5 g kg - 1 min - 1 ; : : 50 g/ kg 01375 01750 g d2sotalol dofetilide GESICA ( Grupo de Edtudio de la Sobrevida en la Insufi2 ciencia Cardiaca en Argentina) 516 2 28 %( P = 01024) 31 % ( P = 01002 4) CHF STA T (Congestive Heart Failure : Sur2 vival Trial of Antiarrhythmic Therapy) 674 45 ( P = 0160) 11 ( ) : ( P = 0107 16 % 0108) LV EF d2sotalol dofetilide [ SWORD (Survival With Oral d2sotalol) DIAMOND (Danish Investiga2 tions of Arrhythmia Mortality On Dofetilide) ] : (1) (2) 012 g 3 5 7 d ; ( ) 012 g 2 5 7 d ; 012 g 1 2 012 g 2 5 d 012 g 1 2 3 41 (3) 51 21 61 : 31 : : : 2
2002 8 17 4 ( 116 ) 263 ; cheyne2 stokes g gn YHA : ;ACE g gn YHA :ACE ; ; 2 ; g gn YHA :ACE ; ; 2 ; g gn YHA :ACE ; ; 2 g ACE 2 g ; 1 % 3 % : : 11 : 2 3 21 LV EF 31 2002 1 30 1