2013年美国心力衰竭管理指南(心衰指南)-英文

6.3. Biomarkers: Recommendations .................................................................................................................. 29

6.3.1. Natriuretic Peptides: BNP or NT-proBNP ........................................................................................ 30

6.3.2. Biomarkers of Myocardial Injury: Cardiac Troponin T or I ............................................................. 31

6.3.3. Other Emerging Biomarkers.............................................................................................................. 32

6.4. Noninvasive Cardiac Imaging: Recommendations ..................................................................................... 32

6.5. Invasive Evaluation: Recommendations ..................................................................................................... 35

6.5.1. Right-Heart Catheterization ............................................................................................................... 36

6.5.2. Left-Heart Catheterization ................................................................................................................. 37

6.5.3. Endomyocardial Biopsy .................................................................................................................... 37

7. Treatment of Stages A to D ............................................................................................................................ 38

7.1. Stage A: Recommendations ........................................................................................................................ 38

7.1.1. Recognition and Treatment of Elevated Blood Pressure ................................................................... 38

7.1.2. Treatment of Dyslipidemia and Vascular Risk.................................................................................. 38

7.1.3. Obesity and Diabetes Mellitus........................................................................................................... 38

7.1.4. Recognition and Control of Other Conditions That May Lead to HF ............................................... 39

7.2. Stage B: Recommendations ........................................................................................................................ 40

7.2.1. Management Strategies for Stage B ................................................................................................ 41

7.3. Stage C ........................................................................................................................................................ 43

7.3.1. Nonpharmacological Interventions ................................................................................................... 43

7.3.1.1. Education: Recommendation ....................................................................................................... 43

7.3.1.2. Social Support .............................................................................................................................. 44

7.3.1.3. Sodium Restriction: Recommendation ......................................................................................... 44

7.3.1.4. Treatment of Sleep Disorders: Recommendation ........................................................................ 45

7.3.1.5. Weight Loss ................................................................................................................................. 45

7.3.1.6. Activity, Exercise Prescription, and Cardiac Rehabilitation: Recommendations ........................ 45

7.3.2. Pharmacological Treatment for Stage C HFrEF: Recommendations ................................................ 46

7.3.2.1. Diuretics: Recommendation ......................................................................................................... 47

7.3.2.2. ACE Inhibitors: Recommendation ............................................................................................... 49

7.3.2.3. ARBs: Recommendations ............................................................................................................ 51

7.3.2.4. Beta Blockers: Recommendation ................................................................................................. 53

7.3.2.5. Aldosterone Receptor Antagonists: Recommendations ............................................................... 55

7.3.2.6. Hydralazine and Isosorbide Dinitrate: Recommendations ........................................................... 58

7.3.2.7. Digoxin: Recommendation .......................................................................................................... 59

7.3.2.8. Other Drug Treatment .................................................................................................................. 61

7.3.2.8.1. Anticoagulation: Recommendations ..................................................................................... 61

7.3.2.8.2. Statins: Recommendation ...................................................................................................... 63

7.3.2.8.3. Omega-3 Fatty Acids: Recommendation .............................................................................. 63

7.3.2.9. Drugs of Unproven Value or That May Worsen HF: Recommendations .................................... 64

7.3.2.9.1. Nutritional Supplements and Hormonal Therapies ............................................................... 64

7.3.2.9.2. Antiarrhythmic Agents .......................................................................................................... 65

7.3.2.9.3. Calcium Channel Blockers: Recommendation ...................................................................... 65

7.3.2.9.4. Nonsteroidal Anti-Inflammatory Drugs ................................................................................ 66

7.3.2.9.5. Thiazolidinediones ................................................................................................................ 66

7.3.3. Pharmacological Treatment for Stage C HFpEF: Recommendations ............................................... 68

7.3.4. Device Therapy for Stage C HFrEF: Recommendations .................................................................. 70

7.3.4.1. Implantable Cardioverter-Defibrillator ........................................................................................ 71

7.3.4.2. Cardiac Resynchronization Therapy ............................................................................................ 72

7.4. Stage D ........................................................................................................................................................ 77

7.4.1. Definition of Advanced HF ............................................................................................................... 77

7.4.2. Important Considerations in Determining If the Patient Is Refractory.............................................. 77

7.4.3. Water Restriction: Recommendation ................................................................................................ 79

7.4.4. Inotropic Support: Recommendations ............................................................................................... 80