LVEF <45% 65%-90% 50%-70%

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??????

• ??????
• ??????
• ??????

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????????

• ??? ??? ???
• LVEF lt45 65-90 50-70
• LV?? ? ??/?? ??/???
• SV ?? ??/ ?
  ??/ ?
• ??/?? ? ?
  ??
• ??? ??/ ? ??
  ??
• ?? ?/?? ???? ?????
• MR/TR ? MR
  ???

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??????

• Dilated Cardiomyopathy

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• ?????????????????????
• ??????, ?????, ???, ????????????

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??????????

• ???????
• ????
• ??
• ????
• X?????gt0.50-0.55
• ECHOLVEDDgt60mm
• ??????
• Echo,????LVEFlt40-45
• LVEDVIgt80ml/m2

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??????

• ????
• CO
• ???? RAAS
• ?? ?? ????
• ??? ????
• ???? ????
• ??????? ????
• ????
• ??????

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?????? ? ?

• ???
• ACE???
• ??????
• ??????
• ????

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ACEI??????

• ??RAAS(??????)
• ???????
• ??????
• ???????II,???????,???????(???????,???)

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ACEI????

• 30??7000??,???,????????ACEI??????
• ?????16-28
• ????AMI?????????
• ????,??????,??????
• ??????,EF??
• ???????
• ?????????

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ACEI??

• ???????????????
• LVEFlt40, NYHA??? I?II?III?IV?????
• ??,???
• ?????,???????????
• ?enalapril 10mg/d
• captopril 150mg/d
• ramipril 10mg/d
• ?? (1)Crgt3mg/dl (2)??? (3)??????
  (4)??ACEI??????????,??????,????,?????

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????????CHF

• ??????
• ??? ????? ????? ?????
• ??? ????? ????II ????
• ?????
• ??????

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MERIT-HF???????????????

• 3991? LVEF0.40 NYHA II-IV
• ??????????
• ???????12.5mg/d?25mg/d?200mg/d
• ????1?
• ??(??????)
• ???? ?34(P0.00009)
• ?????? ?38(P0.00003)
• ?? ?41(P0.0002)
• ?????? ?49(P0.0023)

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CIBIS II(The Cardiac Insufficiency Bisoprolol
Study II)

• 2647? NYHA III-IV LVEF0.35
• ??????????
• ????1.25mg/d?10mg/d
• ??16?
• ??
• ??????156/1327
• ????? 228/1320
• ?????????34 (Plt0.0001)

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????????(??????????)

• PRECISE
• (Prospective Randomized Evaluation of
• Carvedilol on Symptoms and Exercise)
• MOCHA
• (Multicenter Oral Carvedilol Heart failure
  Assessment Study)
• Mild Heart Failure
• Sever Heart Failure
• ??????????65(P0.0001)

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COPERNICUS(Carvedilol Prospective Randomized
Cumulative Survival Trial)

• ?????????????????
• 2289????????????,??????,LVEFlt25
• ??????(ACEI????)2?
• Carvedilol 3.125mg/d?25mg/d ???????
• ??
• Carvedilol?????35(P0.00014)
• 74??????????(50mg/d)

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???????????

• ?????????,NYHA II-III,LVEF40
• ?????????(ACEI????????)2-4w
• ?????,?2w??????????????
• ????Carvedilol 3.125mg bid, Metoprolol
  6.25mg bid,
• Bisoprolol 1.25mg/d)
• ???? Carvedilol 25mg bid, Metoprolol 50mg
  bid
• Bisoprolol 5mg/d
• ???????????????
• ?????????,Carvedilol??????,5-10??????
• 3???????
• ????????,????(HRlt60/min), II???AVB
• ???????,
• ???????,??????,???

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??????

• Restrictive Cardiomyopathy
  

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??????

• ????
• ?????????,??????
• ????????
• ??????????????

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??????

• ????
• Amyloidosis ????
• Hemochromatosis ???
• Sarcoidosis ???
• Radiation heart disease ??????
• Glycogen storage diseases?????
• Familial neuromuscular disorders
• ?????????

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??????

• ???????
• Lofflers syndrome
• Endomyocardial fibrosis

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?????? ????

• ?? ????
• ???????? ??,??,????
• LVEDP ??? ???
• ????? ????
• ??? ??????
• ??
• ??????????

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???????????????

• ?????? ??????
• LAP-RAP?5mmHg LAPRAP
• ?TR ??TR
• RVSPgt50mmHg RVSPlt50mmHg
• RV???????? RV????????
• ???DopplerE?
• ?????lt15 ?????gt25
• ??????? ???