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1、Tohru Izumi, Toshimi Koitabashi, Mototsugu Nishii, Takayuki Inomata Department of Cardio-Angiology, Kitasato University School of Medicine, Sagamihara 288-8555, Japan,Oct 23rd, 2008, Beijing,How to Prevent From Worsening of Chronic Heart Failure,The 4 th China-Japan Cardiovascular Forum (CJCF),Chron
2、ic Heart Failure and Disease Burden,BNP guided therapy for CHF patient,Reduction of cardiac event (disease burden),Indicator: BNP,CHF,ACEI+BB Tx,Comprehensive management,Diuretics,* Plasma BNP level is titrated by RIA using Shionoria (Shionogi, Osaka),In two years follow-up, there were significantly
3、 lower cardiac events, readmission, in BNP guided Tx in comparison with the clinical guided Tx. Cumulative rate of the event within one year reduced from 31.5 to 16.6%.,Inomata T, et al. Jpn Circ J 2001;65 (S-1A), 282.,Group I,Group II,SR,SR,Af,Af,Koitabashi T, Inomata T, et al. ESC 2004,BNP guided
4、Tx cancelled out prognostic contribution by AF in CHF management,Altered prognosis of Af Pts by introducing BNP guided Tx,HF-event-free survival(%),Group II BNP guided era(00-02),Group I Clin guided era (96-98),BNP and Arrhythmic Prognosis,KITASATO UNIVERSITY,Cost-effectiveness of BNP gTx,Morimoto T
5、, Izumi T, Fukui T et al, Int J Cardiol, 2004,Clinical Indicator,Check Point for CHF Management,Dry+Warm,BNP200,New Index?,Hospitalization,Lethal/Disability,Therapeutic plan,Fundamental TX,Adjunctive TX,Reinforce TX,Default,LVAD/HTX,Total Bililbin,Care/Hospice,Cardiac Resynchronization Therapy (CRT)
6、 vs. Reverse Remodeling,Before CRT,Two weeks later,One year later,Echocardiogram（TMF）after CRT,Before CRT,One year later,Reverse Remodeling and -Blocker（Carvedilol）,Dilated Cardiomyopathy vs. Reverse Remodeling,Immunohistochemical Staining for NFB,Wohlschlaeger J, Baba AH et al, Cardiovas Res、2005,C
7、linical Indicator,Check Point for CHF Management,Dry+Warm,BNP200,Reverse Remodeling,Hospitalization,Lethal/Disability,Therapeutic plan,Fundamental TX,Adjunctive TX,Reinforce TX,Default,LVAD/HTX,Total Bililbin,Care/Hospice,Anti-Remodeling and Reverse Remodeling,Mancinid & Burkhoff，Circulation, 2005,A
8、cute Heart Failure,Chronic Heart Failure,Primary Endpoint (J-WIND),Ejection Fraction (EF) in Chronic Stage,Control,（,（,n=187,n=187,）,）,Nicorandil,（,（,n=190,n=190,）,）,p=0.460,p=0.460,36,36,40,40,44,44,48,48,0,0,(%),(%),Control,（,（,n=199,n=199,）,）,ANP,（,（,n=155,n=155,）,）,36,36,40,40,44,44,48,48,0,0,(%
9、),(%),p=0.024,p=0.024,左,左,室,室,駆,駆,出,出,率,率,hANP,Nicorandil,左,左,室,室,駆,駆,出,出,率,率,43.2%,42.5%,44.7%,42.5%,The PREAMI Investigators, Arch Intern Med 2006,Anti-remodeling & Perindopril,In,Six Months BNP & CV Events,Nishii M et al: JACC 51(24):2329-35, 2008,Six Months BNP & Reverse Remodeling,LVEF,at disch
10、arge,at 6 months,P=0.005,at discharge,at 6 months,LVDd,Nishii M et al: JACC 51(24):2329-35, 2008,Six Months BNP Reverse Remodeling,Summary BNP guided therapy produces a superior and excellent outcome through physicians awareness toward their proper treatment. However, the BNP measurement is not almighty diagnostic tool leading to comprehensive CHF management. As a new check point, “anti-remodeling/reverse remodeling should be selected with care as a strong candidate.,