ESC2012

7.2.3

[(H-ISDN)
]

7.2.4 ARB
109
ARB ACEI EF 40%
ACEI -ARB EMPHASIS-HF
- ARB
RALES EMPHASIS-HF MRA ARB

2 RCT[(Val-HeFT) CHARM-Added] 7600
ARB ACEI
110111
Val-HeFT 93% CHARM-Added 100%
Val-HeFT 35% CHARM-Added 55% -
CHARM-Added RRR 16%
ACE - MRA
ARB Val-HeFT
RRR 24% CHARM-Added RRR 17%
- ARR 4.4%
CHARM-Added NNT 41 1
23
Val-HeFT ARR3.3%
NNT 23 30
ARB ARB

CHARM- Alternative RCT 2028 LVEF 40%

ACEI RRR 23% 34 ARR7%
108 109
NNT14 Val-HeFT ACEI
118
[(ELITE)II ] 50 mg/d
50 mg Tid RCT[ II
119
(HEAAL) ] 150 mg/d 50 mg/d(ATLAS)
HEAAL 4.7 RRR
90 119
10%( P=0.027) ATLAS HEAAL
RAS RCT
120
ARB RCT (VALIANT) 14 703 AMI
LV
[ II
121
(OPTIMAAL) ] 50 mg Qd
102
ARB 11
7.2.5

If (SHIFT) 6588 NYHAII-IV
112
, 70 b.p.m.EF35% 12
7.5 mg Bid
(84%)(22%)ACEI(79%)ARB(14%)-(90%) MRA (60%)
26%- 23
RRR 18%( P<0.0001)
RRR 26%- ARR 4.2% NNT 23
1 24
5% 1%( P<0.0001)
RCT If
-(BEAUTIFUL)10917 EF<40%
7.5 mg Bid 19
122
MI
7.2.6

10.1 LVEF40%
113


3
RRR 28%ARR 7.9% NNT3 1 13

123

7.2.7 H-ISDN
ACEI - RCT
14-116
RCT H-ISDN
ACEI- MRA
116
RCT

 H-ISDN (V-HeFT-I A-HeFT) RCT
114-116
(V-HeFT-II) RCT
V-HeFT-I 642 H-ISDN
114
- ACEI MRA
H-ISDN 2.3
RRR22%ARR 5.3% NNT 19H-ISDN LVEF
A-HeFT 1050 NYHA III-IV
H-ISDN ( 90%),(60%), ACEI(70%),ARB(17%), -
116
(74%),(39%) 20 mg ISDN/37.5 mg Tid,
40 mg/75 mg Tid 10 RRR43% ARR
4.0% NNT 25)H-ISDN (RRR 33%)

V-HeFT-II 804 NYHA IIIII H-ISDN

115
- 2.5
H-ISDN 28%
H-ISDN / V-HeFT
I II H-ISDN 5-10%
2-3%
7.2.8 Omega-3 n-3 PUFAs
GISSI-HF n-3 PUFAs
117
n-3 PUFAs

GISSI-HF PUFA 6975 NYHA II-IV EF40% EF>40% 1
n-3 PUFA 1g Qd
117
ACEI/ARB 94%, - 65% 39% 3.9 n-3 PUFA
RRR 8% P=0.009)
RRR 10% P=0.045) RRR 7% P=0.026)
124
RCT(GISSI-Prevenzione )
125
(OMEGA )GISSI-Prevenzione 11 324 (3 )
n -3 PUFA 1 g Qdn -3 PUFA
RRR 10%
OMEGA 3851 AMI 3-14 n -3 PUFA 1g Qd
1
n -3 PUFA
n -3 PUFA
7.3
7.3.1 3--3 A

126
2
127128

(CORONA) GISSI-HF
127128

CORONA 5011 EF40%(60 )(NYHA II-IV )

127

GISSI-HF 4574 EF40% EF>40%
1 (NYHA II-IV )
ACEI/ARB 94%, - 63% 40% 3.9

7.3.2
- RCT
129130
ACEI ARB
7.3.3 OAC
HF-REF HF-PEF
130
10.1 -
7.4
NYHA II-IV



131
III A
133
CCB 134
III B

-2 13
5
III B
13
6
ARB ACEI MRB
III C -

7.5
ACEI- MRA
EF


HF-REF

HF-PEF
HF-REF ACEIARB MRA
/

15 16

ACEI MRA ARB
ACEIARB MRA

ACEIMRA ARB
16 HF-REF HF-PEF
(mg) (mg)
a

2040 40240
0.51.0 15
510 1020
b

2.5 2.510
25 12.5100
2.5 2.510
c
2.5 2.55
d

+ACEi/ ARB -ACEi/ARB +ACEi/ARB -ACEi/ARB

/ 12.525 50 50 100200
2.5 5 510 1020
25 50 100 200
A/B
<30 mL/minC
DMRA/ MRA

8. HF-PEF
HF-PEF
HF-REF
AF 11 <30
CCB
137138
CCB AF
HF-REF -
 HF-PEF AF CCB HF-REF 7.4
HF-PEF
3023 CHARM-Preserve
139

850 PEP-CHF
140

4128 I-Preserve
MI
9. HF-REF
ICD CRT 2008 ICD
1
CRT RCT
142
/

9.1

143
ICD
9.1.1

ICD
EF 1 ICD
144147

9.1.2

SCD-HeFT) 2521
EF35% NYHA II-III ACEI
ARB96%-(69%)MRA
149
ICD
45.5 ICD RRR 23% ( P=0.007)
ACEI -
ICD



144
I A
>1 ICD 147
NYHA II-III ) - - -
35%>1 ICD - - -

(i) >40 I A 148

(ii) I B 149
148
ICD (MADIT-II) MIEF
30% 59% NYHA IIIII ) RCT ICDICD
 RRR 31% RCT MI ( 40 ) ICD
150151
ICD CAD A AMI 40
1 [
152
DEFINITEn =458] B
3 EF ICD
NYHA IV CRT
ICD
153
ICD
ICD

NYHA III IV
CRT



LBBB QRS QRS 120 ms LBBB QRS EF I A 156,
35%>1 CRT-P/CRT-D 157

LBBB QRS QRS QRS 150 msEF IIa A 156,

35%>1 CRT-P/CRT-D 157

CRT-D=-CRT-P=-LBBB=

92
154155 156157
2 RCT CRT NYHA II
1
LVEF (30%)QRS (150 ms) ECG
CRT
AF
CRT
158
HF-REF QRS > 120 ms
159160
CRT
NYHA II
CRT



LBBB QRS QRS 130 ms LBBB QRS EF
154
30%>1 CRT CRT-D I A
155

LBBB QRS QRS QRS 150 ms

154
EF 30%>1 CRT IIa A
155
CRT-D

CRT-D=-LBBB=
9.2.1


2 RCT[
COMPAN-IONCARE-HF 2333
156157
NYHA III-IV CRT
COMPANION EF35%QRS 120 ms
CARE-HF EF35%QRS 120 ms
QRS 120-149 ms LV
30 mm
CRT [ COMPANION
CRT-(CRT-P) RRR 24% CRT- (CRT-D) RRR 36%
CARE-HF CRT-P RRR 36%] CARE-HF CRT-P RRR 52%
ACEI- MRA
COMPANION 16 CRT-D
RRR 8.6% 12 NNT CARE-HF
29 CRT-P RRR 16.6%NNT 6
CRT

CRT NYHA
IIIIV CRT

RCT 3618 MADIT-CRT NYHAI 15%
NYHA II 85%[/RAFTNYHA II 80%
NYHA III 20%] ICD
154155
CRT-D MADIT-CRT EF 30%QRS 130 ms
RAFT EF30%QRS 120 ms ( 13% AF
)
CRT ( MADIT-CRT )
MADIT-CRT RRR 34% RAFT RRR 25% RAFT
25%( P=0.003) MADIT-CRT
ACEI-MRA ICD
MADIT-CRT -ARR 8.1%
NNT 2.4 1 12 RAFT ARR 7.1% NNT 14
40
CRT

MADIT-CRT RAFT QRS

QRS150 ms CRT LBBB
LBBB
 161
QRS 150 ms)
QRS 150 ms 130 ms LBBB CRT
9.2.2
CRT AF EF
CRT

[MUSTIC)] 59 HF-REF
162
/ AF QRS 200 ms
3 3 CRT42% 6
RAFT CRT RCT AF
158
RAFT 229 AF 60 b.p.m6
90 b.p.m.)
RCT
163
AF

RAFT CRT RCT RAFT
155
135 QRS 200 ms

(NYHAII-IV ) EF
CRT

NYHA III QRS 120 msEF 35%>1

CRT-P/CRT-D
B -
B -
60 b.p.m.90 b.p.m. B -
CRT
>1
QRS NYHAIII-IV EF35% CRT IIa C -

QRS NYHAEF35% CRT IIb C -

CRT-D=-CRT-P=-
LBBB
164165
LV
HF-REF CRT
10HF-REF HF-PEF
143
ESC
 AF AF
AF

AF AF
166

AF AF

/

10.1.1

*
- HF-REF
HF-REF
3 /
( II-IV )/

1 -
I A 92-9
8

1
1. I B 113
2. IIb C -

3. IIb C -
(
CRT)
2
I B 113

2
1. IIb C -
1

2. IIb C -

( CRT)
( IIb C -
)
III
AF 3 HF-REF
HF-REF -
167
-
168
-- HF-PEF
CCB- HF-REF
134167
CCB
 CCB
AF
170
RCT
AF-CHF
171
<80 /6 <110 /
CRT
164
9.2