ESC

2012
2012
HFA

5 2012

/ : John J. V. McMurray ( ) ( )* ,Stamatis

Adamopoulos (), Stefan D. Anker (), Angelo Auricchio(),
Michael Bo hm (), Kenneth Dickstein (),Volkmar Falk (),
Gerasimos Filippatos (), Ca ndida Fonseca(), Miguel Angel
Gomez Sanchez (), Tiny Jaarsma (),Lars Kber (), Gregory
Y. H. Lip (), Aldo Pietro Maggioni (),Alexander Parkhomenko (
), Burkert M. Pieske (), Bogdan A. Popescu(), Per K.

1
Rnnevik (), Frans H. Rutten (),Juerg Schwitter (), Petar
Seferovic (), Janina Stepinska (),Pedro T. Trindade (),
Adriaan A. Voors (), Faiez Zannad(), Andreas Zeiher ()

ESC (CPG): Jeroen J. Bax (CPG ) (),Helmut

Baumgartner (), Claudio Ceconi (), Veronica Dean (),
Christi Deaton (),Robert Fagard (), Christian Funck-Brentano
(), David Hasdai (), Arno Hoes (),Paulus Kirchhof (/
), Juhani Knuuti (), Philippe Kolh (), Theresa McDonagh (
),Cyril Moulin (), Bogdan A. Popescu (), Zeljko Reiner (
), Udo Sechtem (),Per Anton Sirnes (), Michal Tendera (
), Adam Torbicki (), Alec Vahanian (),Stephan Windecker (
)

: Theresa McDonagh (CPG ) (), Udo

Sechtem (CPG ) (), Luis Almenar Bonet (),
Panayiotis Avraamides (), Hisham A. Ben Lamin(), Michele
Brignole (), Antonio Coca (), Peter Cowburn (), Henry
Dargie (), Perry Elliott(), Frank Arnold Flachskampf (),
Guido Francesco Guida (), Suzanna Hardman (), Bernard Iung (
), Bela Merkely (), Christian Mueller (), John N. Nanas (
),Olav Wendelboe Nielsen (), Stein rn (), John T. Parissis (
), Piotr Ponikowski ()

: John J.V. McMurray, G12 8QQ,

UK. Tel: + 44 141 330 3479, Fax: + 44 141 330 6955, Email:
john.mcmurray@glasgow.ac.uk
ESC:
:(EACPR),(EAE),
(EHRA),(EAPCI)

2
,

ESCESC,

- -

1. 3.6.2
2.
3. 3.6.3 :
3.1
3.2 3.6.4
3.3 3.6.5 X
3.4 3.6.6
3.5 3.6.7
4.
3.6
3.6.1 4.1
4.1.1
5.3
4.1.2 5.4
4.2 6.
4.3 7. EF ()
4.4
4.5 7.1
7.2
4.6
4.7 7.2.1 -
4.8
5. 7.2.2 /
5.1 7.2.3
5.2

3
7.2.4 11.10
7.2.5 11.12
7.2.6 11.13
7.2.7 11.14
11.14
7.2.8 - 3 11.15
7.3 () 11.16
7.3.1 A 11.17
() 11.18
7.3.2 11.19
7.3.3 12.
7.4 () 12.1
7.5 12.2
8. () 12.2.1
12.2.2 /
9. EF () 12.3
12.3.1
9.1 12.3.2
9.1.1 12.4
9.1.2 12.5
9.2 12.6
9.2.1 12.7
12.7.1
9.2.2
12.7.2
10. EF EF 12.7.3
, 12.7.4
10.1 12.7.5
10.1.1 12.7.6
10.1.2 13. ,
10.1.3
10.2 13.1
10.3 13.2
11. EF EF 13.3
13.3.1
11.1 13.3.2
11.2 13.3.3
11.3 13.4
11.4 : 13.5
11.5 13.5.1
11.6 13.5.2
11.7 14.
11.8. ,
11.9 14.1

4
14.2 :(31011121315)
14.3 ESC
14.4 () 6
14.5 ()
14.6
14.7 //
15.
15.1
15.2
15.3
15.4
15.5

15.6
15.7

ACE BTR
ACHD BTT
AF CABG
AF-CHF CAD
AHF CARE-HF
AIRE
ARB CCB
ARR CHA2DS2-VAS
ATLAS 75(2 )
AV (2 )-
AVP 65 - 74 ()
BEAUTIFUL If CHARM :

CIBIS II II
BEST - CMR
BiVAD COMET
BNP B- COMPANION
b.p.m.
BTC CONSENSUS
BTD

5
COPD HEAAL II
COPERNICUS
HF
CORONA HF-ACTION :

CPAP HF-PEF
CRT HF-REF
CRT-D I-PRESERVE
CRT-P
CT IABP
DEFINITE ICD
LA
DIG LBBB
DT LV
ECG LVAD
ECMO LVEF
EF MADIT-II
eGFR II
ELITE II MCS
MDCT CT
EMPHASIS-HF MERIT-HF

GFR MRA
GISSI-HF MR-proANP A

H-ISDN MUSTIC
HAS-BLED NIPPV
( 1 ) NNT 1 1
INR (
65 )/ 1 NSAID

6
NYHA
OPTIMAAL II

PEP-CHF

PET
PUFA
RAFT /

RALES
RCT
RRR
SAVE
SCD-HeFT

SENIORS

SHIFT If

SOLVD
SPECT
STICH
TAPSE
TDI
TOI
TRACE
Val-HeFT
VALIANT
VO2

7

 1.

-
ESC

ESC

ESC ESC
( http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pag
es/rules-writing.aspx) ESC ESC

ESC
ESC CPG

-
A B

A

/ /

/
/
a //
b //
/

B
A
B
C /

8

ESC (http://www.escardio.org/guidelines )
ESC
ESC
ESC CPG
ESC CPG

CPG
ESC

ESCESC
ESC

2
2008
:
(1) MRAs
(2)
(3) CRT
(4)
(5)

9
(6)

LV
CHF

3
3.1
,

3.6
2 - 6

3.6

3.5
LV

3.2 LV
LVEF
EF
LV
LV

10
EF

EF EF
EF
EF HF-REF
EF 35%

EF 4045%

EF 50%

EF HF HF-PEF
EF 35 50%
HF-PEF HF-REF

78
LV
4.1.2)

78
EF

EF 4.1.1 )
EF 910
1
HF-REF 3
1HF
a
2HF
3LVEF
HF-PEF 4
1HF
a
2HF
3LVEF LV
4LV /LA / 4.1.2
HF=;HFPEF=;
HFREF=;LA=;LV=;

11
LVEF=;
HF-PEF

3.3

NYHA
3.4 2

LV

AMI

LV
ACEI- MRA

3.4
NYHA 2
NYHA
I NYHA II, III IV

12


11-13

NYHA
IV

Killip AMI 14
2

3.5
1-2% 70
10%15
3 EF HF-REF
HF-REF

CAD 2/3

16
HF-PEF HF-REF 1718HF-PEF
HF-REF CHD
AFHF-PEF HF-REF

13
 19
LV MI

1120
EF
LV
EF
MI

-
-RAS

1120

LV
[ AF
LBBB]

1990
60 -70% 5
21-23
30-50%
21-23
4




3

14


2kg/W


16 /

3.6
3.6.1

4

2-6

2-6

24-26

2-5
MI

15
 3

3.6.2

C

a
b

4.1.2 I C

LVEF
12 ECG QRS I C

5
ECG
//eGFR I C

/TIBC
(1)RAS
(2)/

(3)
I C

(1)

(2)
BNP, NT-proBNP MR-proANP IIa C

(1) 1

(2)
X IIa C

/COPD/

CMR LVEF I C

CMR /
I C

CAD / IIa C

16
CMRSPECT PET

I C

IIa C

(1)
(2)
(3)
4
BNP= B-; CAD=; CMR =; COPD=; ECG=
;HF=; LV=; LVEF ; MR-proANP=;
NT-proBNP=N-; PET=; SPECT=
; TIBC =. a , b . c
/D-

3.6.3
ECG

7-1029-34
ACEI -
ECG
4
ECG
AV 5

AF
LBBB CRT
9.2
ECG LV Q

ECG 2%2335-38
ECG
10-14%

RAS
HF 3.6.6

17
 5

AV
//

/

ICD
/ /

Q LBBB /

/CMR
AV
/ICD
QRS /CMR

CMR, 99mTc-DPD

QRS C RT- P, C RT- D
120 ms
LBBB

AV=CMR=CRT-P=CRT-D
ECG=HF=ICD=LBBB=LV=
99mTc-DPD=technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid.

CAD

4 5
3.6.4

18
 AF
39-42
6

(creatinine >150 ACE I/ARB, eGFR ACE I/ARB MRA
mol/L/1.7 mg/dL, eGFR MRA
BUN
<60 mL/mim/1.73 m2) NSAIDs

(<13 g/dL/8.0 CHF, ,
mmol/L , <12 g/dL/7.4
mmol/L )

(<135 mmol/L) CHF AVP

(>150 mmol/L) /
(<3.5 AECI/ARB
mmol/L) MRA
(>5.5 RAS //
mmol/L) ACEI/ARBMRA pH

(>6.5
mmol/L/117 mg/dL)

(>500
mol/L/8.4 mg/dL)

(>45
g/L)
(<30
g/L)


HF
HF /

(laminopathy,

desminopathy, dystrophinopathy),

/

DM
INR>3.5 /

CRP >10 mg/L,

19
ACE= ARB= AVP=
BNP= B-BUN=CRP=C-
eGFR= HF= MRA=NSAID=

26

3942
39-50

B-BNP N- B-NT-proBNP
43-50

NT-proBNP 300 pg/mLBNP 100 pg/mL

A MR-proANP) 120 pmol/L
BNP NT-proBNP 51 BNP
NT-proBNP 43-50
NT-proBNP 125
pg/mL BNP 35 pg/mL
3.6.5 X
X

LV
3.6.6
/eGFR

6

DM

RASI 7.2

20
 NSAID

3.6.7
*
,MR-proANP(120 pmol/ L,< 120 pmol / L =)
BNP= BECG=HF=MR-proANP = NT-proBNP= N-B

A:
B:
COPD(>75
)COPD
C: HF-PEF
D:3.53
1.HF----()(

LV 1

21


39-50

ECG

ECG

39-50

MI

22