ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－278－JS1-1 Asian acute heart failure guidanceCardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi hospital, JapanNaoki SatoAcute heart failure（AHF）is increasing in prevalence and is a public health problem in the Western countries as well as inAsia. The most critical issues of AHF are high mortality and readmission rates. To solve these issues, recently several AHFpractical guidances have been published by European and American groups. Indeed, most of AHF managements are conducteddespite lack of evidence by emergency physicians, intensivists, cardiologists, and internal medicine physicians. However, theseguidances suggest that cooperation and homogenization of AHF management are key in improving the outcome. In Asiancountries, there are variations for pharmacological and non-pharmacological managements. Therefore, Asian AHF guidanceshould be also needed to achieve the same goal of the Western AHF guidances. In this lecture, first, the differences in AHFmanagements between Asian countries will be shown. Second, I would like to emphasize the benefit of “the earlier, the better”AHF management based on evidences including Asian studies.シンポジウム（合同企画） 1 2月13日（土）　9：00～10：50　第5会場急性心不全国際会議: Topics of acute heart failure: the patient with AHF on the ICU/CCUJS1-2 Organ damage in acute heart failureDepartment of Anesthesia and Critical care, University Hospitals Saint Louis-Lariboisiere; U942 Inserm; University ParisDiderot, Paris, France.Alexandre Mebazaa　Acute heart failure（AHF）is defined as a rapid onset of or deterioration in the signs and symptoms of heart failure（HF）with an abnormality of cardiac structure or function, and requiring urgent treatment. It may present as new HF（also called denovo HF）or worsening HF in the presence of chronic HF. This definition already described repeatedly in various ESCguidelines is still valid. Acute heart failure is seen today as related to congestion rather than low cardiac output. Congestionhelps to maintain cardiac output but has some side effects upstream the ventricles. This includes organ congestion leading toalteration in their function. The paper explains how to assess organ dysfunction in acute heart failure.1. Assessment of cardiorenal syndrome　Both cardiovascular and renal diseases are common and frequently coexist in the same patient. Acute renal dysfunctionoccurs as a consequence of new kidney injury or acute deterioration of pre-existed chronic kidney disease. Compared with newonset kidney injury, acute deterioration of pre-existed chronic kidney disease was associated with higher risk for in-hospitalmortality, long hospital stay, and failure in renal function recovery. Five categorizes of cardiorenal syndrome（CRS）aredescribed. Serum creatinine is used to derive the glomerular filtration rate（GFR）as an indicator of kidney functionnevertheless in ICU patients GFR is frequently overestimate due oedema and volume overload typical for AHF.　Several new biomarkers of early stage of kidney damage, cystatin C and neutrophil gelatinase-associated lipocalin（NGAL）,have been identified to diagnosis early AKI before a significant increase in serum creatinine level and can lead to earlier specifictherapies to repair or prevent progression. Cystatin C is a protein produced at a constant rate by all nucleated cells, entirelyfiltrates by glomeruli and metabolized by tubules cells. Increase serum Cystatin C（sCyC）levels is a biomarker of glomerularfunction. If the predictive ability of sCyC for AKI are still debated but sCyC appeared to be a good biomarker of AKI（38）. In ameta-analysis of 19 studies with 3,336 patients, sCyC appeared to be a good biomarker of AKI（39）ref with a sensitivity andspecificity respectively 86% and 82%. In AHF patient, sCyC was a stronger predictor of the length of hospitalization or death orrehospitalization during 1-year follow-up. sCyC seems to be a promising new risk marker to perform more accurate risk ofpatients with AHF.