右心衰竭诊断和治疗中国专家共识的补充说明-沈节艳

··沈节艳孙灵跃DOI10.3877/[e-mail]。、、。、。。2009《2009》1。2012《》2、、、、。、。。、、。、、、。NYHA6min。、。ASE2010《》3。。1．1＞53mm＞44mm＞18cm2。2IVCIVC＞2.1cm＜50%15mmHg10～20mmHgIVC≤2.1cm≥50%3mmHg0～5mmHg8mmHg5～10mmHg。3＞5mmRVH＞42mm＞35mm＞86mm＞33mm、＞27mm。2．1dp/dtdp/dt。dp/dt＜400mmHg/s。2RIMPTeiTCOTCO=IVCT+ET+IVRTRIMPTei=TCO-ET/ET。RIMP＞0.4RIMP＞0.55。Tei、、。3TAPSETAPSE＜16mm。4FAC＜35%。5S'S'＜10cm/s。3．1EAE/AEDTE/A＜0.80.8＜E/A＜2.1E/E'＞6·7664·20136711ChinJCliniciansElectronicEditionJune12013Vol．7No．11E/AE/A＞2.1DT＜120ms。2E'A'E'/A'E/E'E'/A'＜1E/E'＞6。4．TRBernoulliSPAP。TR2.8～2.9m/sSPAP36mmHg3～5mmHg。4v24v2。STISSR、4。、。3。MRI2010CMR5CMR。CMRMRI、、、、、、、、。CMR、XCMR、。GdLGEMRACC/AHAⅠpositronemissiontomographyPET“”6。LGE。MOSPECTLGE7-8。CMR、、。CMR、。5。CT1．CTmulti-slicecomputedtomographypulmonaryangiographyMSCTPAacutepulmonaryembolismAPE。“”。APE9。Stevinson10。。Ghaye112006MSCTPA。/＞112、11。2．single-photone-missioncomputedtomographySPECT13。MRI14。BB-typenatriureticpeptideBNPNBN-terminalproB-typenatriureticpeptideNT-proBNP。BNP＜100ng/LNT-proBNP＜300ng/LBNP＜35ng/LNT-proBNP＜125ng/L15。D-16。、、CKCK-MB。TSH17。、·8664·20136711ChinJCliniciansElectronicEditionJune12013Vol．7No．11。、。、。、A、B、C、D。A。B。C。D。15-18。1．、、。。2．、。ACEI、ARBβ。ACEIβ。1。。。。、。2。12.5～25.0mg2deplerenone25mg50mg。3。。4L/min2.5L·min－1·m2－1。100/min。NYHAⅠ。。4、。。。Ⅰ。。19。。。3．。。125-3。CCBⅠ～Ⅱ。。FDA。Veletri2012·9664·20136711ChinJCliniciansElectronicEditionJune12013Vol．7No．117ActelionsFDAFDA。Remodu-linTyvaso。beraprost、、20-21。。TRK-100STP126MWD22TRK-100STP23。22-23。IP、SelexipagActelionⅢ、、GRIPHONAC-065A302SelexipagⅠTTCW、6MWDBorg20143。AC-065A302、ⅢNCT01112306AC-065A303Selexipag。20056sildenafilRevatioFDA200911FDARevatio。PDE5Is。200924201125Evaluation、WHO。、PDE5Is。。2013。20124Actelionmacitentan26-27ⅢSERAPHINAC-055-302macitentan、、7424。macitentan3mg10mg/。10mg45%P＜0.0001。3mg30%P=0.0108。SERAPHINmacitentan28。551AC-055-303。rio-ciguatⅢCHEST-129。CTEPH。riociguatCTEPH6min。CHEST-1、N、WHO。ⅢPA-TENT。4．15ICD、CRT-PCRT-D。CRT。HF-REFHF-PEFDDDVVI。3NY-HAⅡ～Ⅲ≤35%＞1ICD。5．。。。。。1HowlettJGMcKelvieRSArnoldJMetal．CanadianCardiovascularSocietyConsensusConfer－enceguidelinesonheartfailureupdate2009diagnosisandmanagementofright－sidedheartfa－iluremyo-carditisdevicetherapyandrecentimportantclinicaltrials．CanJCar-diol20092585-105．2．．201240449-461．3RudskiLGLaiWWAfilaloJetal．Guidelinesfortheechocardio-graphicassessmentoftherightheartinadultsareportfromtheAmer-icanSocietyofEchocardiographyendorsedbytheEuropeanAssocia-·0764·20136711ChinJCliniciansElectronicEditionJune12013Vol．7No．11tionofEchocardiographyaregisteredbranchoftheEuropeanSocietyofCardiologyandtheCanadianSocietyofEchocardiography．JAmSocEchocardiogr201023685-713．4AmundsenBHHelle-ValleTEdvardsenTetal．NoninvasiveMyo-cardialStrainMeasurementbySpeckleTrackingEchocardiographyvalidationagainstsonomicrometryandtaggedmagneticresonanceima-ging．JAmCollCardiol200647789-793．5HundleyWGBluemkeDAFinnJPetal．ACCF_ACR_AHA_NA-SCI_SCMR2010expertconsensusdocumentoncardiovascularmag-neticresonance_areportoftheAmericanCollegeofCardiologyFoun-dationTaskForceonExpertConsensusDocuments．Circulation20101212462-2508．6PennellDJSechtemUPHigginsCBetal．ClinicalindicationsforcardiovascularmagneticresonanceCMRConsensusPanelreport．EurHeartJ2004251940-1965．7WagnerAMahrholdtHHollyTAetal．Contrast-enhancedMRIandroutinesingle-photonemissioncomputedtomographySPECTperfu-sionimagingfordetectionofsubendocardialmyocardialinfarctsanimagingstudy．Lancet2003361374-379．8IbrahimTBulowHPHacklTetal．Diagnosticvalueofcontrasten-hancedmagneticresonanceimagingandsingle-photonemissioncom-putedtomographyfordetectionofmyocardialnecrosisearlyafteracutemyocardialinfarction．JAmCollCardiol200749208-216．9GolpeRPérez-de-LlanoLACastro-AónOetal．Rightventricledysfunctionandpulmonaryhypertensioninhemodynamicallysta-blepulmonaryembolism．RespirMed20101041370-1376．10StevinsonBGHernandez-NinoJRoseGetal．Echocardiographicandfunctionalcardiopulmonaryproblems6monthsafterfirst-timepulmonaryembolisminpreviouslyhealthypatients．EurHeartJ2007282517-2524．11GhayeBGhuysenAWillemsVetal．Severepulmonaryembolismpulmonaryarteryclotloadscoresandcardiovascularparametersaspredictorsofmortality．Radiology2006239884-891．12LimKEChanCYChuPHetal．Rightventriculardysfunctionsec-ondarytoacutemassivepulmonaryembolismdetectedbyhelicalcom-putedtomographypulmonaryangiography．ClinImaging20052916-21．13YamagishiTMatsudaYNakatsukaMetal．Assessmentofrightven-triculardiastolicfillinginpatientswithcoronaryarterydisease．ClinCardiol199316816-822．14KjaergaardJPetersenCLKjaerAetal．Evaluationofrightventric-ularvolumeandfunctionby2Dand3DechocardiographycomparedtoMRI．EurJEchocardiogr20067430-438．15McMurrayJJAdamopoulosSAnkerSDetal．ESCGuidelinesforthediagnosisandtreatmentofacuteandchronicheartfailure2012TheTaskForcefortheDiagnosisandTreatmentofAcuteandChronicHeartFailure2012oftheEuropeanSocietyofCardiology．DevelopedincollaborationwiththeHeartFailureAssociationHFAoftheESC．EurHeartJ2012331787-1847．16GoldhaberSZVisaniLDeRosaM．Acutepulmonaryembolism_clinicaloutcomesintheInternationalCooperativePulmonaryEmbol-ismRe