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Chronic Heart Failure – An Update

Chronic Heart Failure – An Update. T P Chua. Royal Surrey County Hospital, Guildford. St George’s Hospital, London. Chronic Heart Failure – Clinically Important. Common (1-5% of population) High Mortality Disabling symptoms Expensive (30% require h ospitalisation / year)

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Chronic Heart Failure – An Update

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  1. Chronic Heart Failure – An Update T P Chua Royal Surrey County Hospital, Guildford St George’s Hospital, London

  2. Chronic Heart Failure – Clinically Important Common (1-5% of population) High Mortality Disablingsymptoms Expensive (30% require hospitalisation/year) Recent Advances

  3. Chronic Heart Failure • Ventricular dysfunction with chronic symptoms of breathlessness and/or fatigue and/or fluid retention • Signs of pulmonary or peripheral congestion • Systolic heart failure more common and better defined than diastolic heart failure Eur Heart J 1995; 16: 741-751

  4. Diastolic Heart Failure • Normal ejection fraction/systolic function • Normal or even small left ventricular chamber volumes • Reduced active relaxation and increased passive stiffness of LV • More than 75% of these patients have hypertension and ~40% have left ventricularhypertrophy Zile MR, et al. NEJM 2004; 350:

  5. Sensitivity & Specificity of Symptoms Sensitivity (%) Specificity (%) Dyspnoea 52 66 81 Orthopnoea 21 PND 33 76 Oedema 80 23

  6. Value of the ECG in Identifying Heart Failure ECG Impaired LV Normal LV Total Abnormal* 90 169 259 Normal 6 269 275 Total 96 438 534 *Abnormal ECG: AF, Previous MI, LVH, BBB, LAD Negative Predictive Value: 269/275: 98% Davie AP, McMurray JJV, et al. BMJ 1996;312:222

  7. Sensitivity & Specificity of ECG,NT-proBNP and Hand-held Echo Sensitivity (%) Specificity (%) NPV (%) 78 99.6 Abnormal ECG 92 Raised NTproBNP 80 88 99 Abnormal ECG or raised NTproBNP 96 72 99.8 Abnormal ECG and raised NTproBNP 76 94 99.7 99.3 Hand-held Echo 93 97 EHJ 2006; 27: 193-200

  8. Natriuretic Peptides Three types present:- • ANP (atrial natriuretic peptide) first discovered; primarily released by atria; potent vasodilator and natriuretic • BNP (B-type natriuretic peptide); predominantly released by left ventricle in response to high filling pressures; also a vasodilator and natriuretic • CNP (C-type natriuretic peptide); released by atria and ventricles; vasodilatory property only

  9. B-type Natriuretic Peptide

  10. Clinical Use of BNP in CHF • Diagnosis of CHF in patients with acute dypsnoea

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