中国扩张型心肌病诊断和治疗指南

中华医学会心血管病学分会、中国心肌炎心肌病协作组. 中国扩张型心肌病诊断和治疗指南[J]. 临床心血管病杂志, 2018, 34(5): 421-434. doi: 10.13201/j.issn.1001-1439.2018.05.001
引用本文: 中华医学会心血管病学分会、中国心肌炎心肌病协作组. 中国扩张型心肌病诊断和治疗指南[J]. 临床心血管病杂志, 2018, 34(5): 421-434. doi: 10.13201/j.issn.1001-1439.2018.05.001
2018 Chinese guidelines for diagnosis and treatment of dilated cardiomyopathy[J]. J Clin Cardiol, 2018, 34(5): 421-434. doi: 10.13201/j.issn.1001-1439.2018.05.001
Citation: 2018 Chinese guidelines for diagnosis and treatment of dilated cardiomyopathy[J]. J Clin Cardiol, 2018, 34(5): 421-434. doi: 10.13201/j.issn.1001-1439.2018.05.001

中国扩张型心肌病诊断和治疗指南

  • 基金项目:

    国家十二五支撑计划 (No:2011BAI11B23)

2018 Chinese guidelines for diagnosis and treatment of dilated cardiomyopathy

  • 前言扩张型心肌病(dilated cardiomyopathy,DCM)是引起心力衰竭(心衰)、心律失常和猝死的常见疾病之一。1985年美国Olmsted县的流行病学调查DCM患病率为36.5/10万[1]。2002年中国分层整群抽样调查9个地区8080例正常人群,DCM患病率为19/10万[2]。1990年欧洲报道DCM的5年病死率为15%~50%[3]。2014年中国一项报道显
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  • [1]

    Codd MB,Sugrue DD,Gersh BJ,et al.Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy.A population-based study in Olmsted County,Minnesota,1975-1984[J].Circulation,1989,80(3):564-572.

    [2]

    王志民,邹玉宝,宋雷,等.超声心动图检查调查8080例成人肥厚型心肌病患病率[J].中华心血管病杂志,2004,32(12):1090-1094.

    [3]

    Komajda M,Jais JP,Reeves F,et al.Factors predicting mortrality in idiopathic dilated cardiomyopathy[J].Eur Heart J,1990,11(9):824-831.

    [4]

    Liu X,Yu H,Pei J,et al.Clinical characteristics and long-term prognosis in patients with chronic heart hailure and reduced ejection fraction in China[J].Heart Lung Circ,2014,23(9):818-826.

    [5]

    Richardson P,McKenna W,Bristow M,et al.Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies[J].Circulation,1996,93(5):841-842.

    [6]

    Maron BJ,Towbin JA,Thiene G,et al.Contemporary definitions and classification of the cardiomyopathies:an American Heart Association Scientific Statement from the Council on Clinical Cardiology,Heart Failure and Transplantation Committee;Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups;and Council on Epidemiology and Prevention[J].Circulation,2006,113(14):1807-1816.

    [7]

    中华医学会心血管病学分会,中华心血管病杂志编辑委员会,中国心肌病诊断与治疗建议工作组.心肌病诊断与治疗建议[J].中华心血管病杂志,2007,35(1):5-16.

    [8]

    Ponikowski P,Voors AA,Anker SD,et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC).Developed with the special contribution of the Heart Failure Association (HFA) of the ESC[J].Eur J Heart Fail,2016,18(8):891-975.

    [9]

    Correction to:2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure:An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure:A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America[J].Circulation,2016,134(13):e298.

    [10]

    Pérez-Serra A,Toro R,Sarquella-Brugada G,et al.Genetic basis of dilated cardiomyopathy[J].Int J Cardiol,2016,224:461-472.

    [11]

    袁璟,廖玉华.抗心肌抗体对心肌炎心肌病临床诊断、治疗和预后评估的价值[J].临床心血管病杂志,2015,31(2):115-118.

    [12]

    Rossi A,Dini FL,Faggiano P,et al.Independent prognostic value of functional mitral regurgitation in patients with heart failure.A quantitative analysis of 1256 patients with ischaemic and nonischaemic dilated cardiomyopathy[J].Heart,2011,97(20):1675-1680.

    [13]

    Rudski LG,Lai WW,Afilalo J,et al.Guidelines for the echocardiographic assessment of the right heart in adults:a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography,a registered branch of the European Society of Cardiology,and the Canadian Society of Echocardiography[J].J Am Soc Echocardiogr,2010,23(7):685-713.

    [14]

    Pinto YM,Elliott PM,Arbustini E,et al.Proposal for a revised definition of dilated cardiomyopathy,hypokinetic non-dilated cardiomyopathy,and its implications for clinical practice:a position statement of the ESC working group on myocardial and pericardial diseases[J].Eur Heart J,2016,37(23):1850-1858.

    [15]

    Mathew T,Williams L,Navaratnam G,et al.Diagnosis and assessment of dilated cardiomyopathy:a guideline protocol from the British Society of Echocardiography[J].Echo Res Pract,2017,4(2):G1-G13.

    [16]

    中华医学会心血管病学分会.心肌病磁共振成像临床应用中国专家共识[J].中华心血管病杂志,2015,43(8):673-681.

    [17]

    Memon S,Ganga HV,Kluger J.Late gadolinium enhancement in patients with nonischemic dilated cardiomyopathy[J].Pacing Clin Electrophysiol,2016,39(7):731-747.

    [18]

    Sibley CT,Noureldin RA,Gai N,et al.T1 mapping in cardiomyopathy at cardiac MR:comparison with endomyocardial biopsy[J].Radiology,2012,265(3):724-732.

    [19]

    Kimura A.Molecular genetics and pathogenesis of cardiomyopathy[J].J Hum Genet,2016,61(1):41-50.

    [20]

    Haas J,Frese KS,Peil B,et al.Atlas of the clinical genetics of human dilated cardiomyopathy[J].Eur Heart J,2015,36(18):1123-1135a.

    [21]

    Hinson JT,Chopra A,Nafissi N,et al.HEART DISEASE.Titin mutations in iPS cells define sarcomere insufficiency as a cause of dilated cardiomyopathy[J].Science,2015,349(6251):982-986.

    [22]

    Caforio AL,Tona F,Bottaro S,et al.Clinical implications of anti-heart autoantibodies in myocarditis and dilated cardiomyopathy[J].Autoimmunity,2008,41(1):35-45.

    [23]

    Hoebeke J.Structural basis of autoimmunity against G protein coupled membrane receptors[J].Int J Cardiol,1996,54(2):103-111.

    [24]

    Liao YH,Fu ML.Autoimmunity in the pathogenesis of cardiomyopathy[J].J Autoimmun,2001,16(1):1-2.

    [25]

    Xiao H,Wang M,Du Y,et al.Agonist-like autoantibodies against calcium channel in patients with dilated cardiomyopathy[J].Heart Vessels,2012,27(5):486-492.

    [26]

    Xiao H,Wang M,Du Y,et al.Arrhythmogenic autoantibodies against calcium channel lead to sudden death in idiopathic dilated cardiomyopathy[J].Eur J Heart Fail,2011,13(3):264-270.

    [27]

    Yu H,Pei J,Liu X,et al.Calcium channel autoantibodies predicted sudden cardiac death and all-cause mortality in patients with ischemic and nonischemic chronic heart failure[J].Dis Markers,2014,2014:796075.

    [28]

    Pei J,Li N,Chen J,et al.The predictive values of beta1-adrenergic and M2 muscarinic receptor autoantibodies for sudden cardiac death in patients with chronic heart failure[J].Eur J Heart Fail,2012,14(8):887-894.

    [29]

    谷晓莹,廖玉华,袁璟,等.抗心肌抗体对中国扩张型心肌病诊断价值的Meta分析[J].临床心血管病杂志,2016,32(10):1030-1038.

    [30]

    Haghikia A,Kaya Z,Schwab J,et al.Evidence of autoantibodies against cardiac troponin Ⅰ and sarcomeric myosin in peripartum cardiomyopathy[J].Basic Res Cardiol,2015,110(6):60.

    [31]

    Liu J,Wang Y,Chen M,et al.The correlation between peripartum cardiomyopathy and autoantibodies against cardiovascular receptors[J].PLoS One,2014,9(1):e86770.

    [32]

    Japp AG,Gulati A,Cook SA,et al.The diagnosis and evaluation of dilated cardiomyopathy[J].J Am Coll Cardiol,2016,67(25):2996-3010.

    [33]

    廖玉华,王朝晖,涂源淑,等.扩张型心肌病的分期及其临床意义[J].临床心血管病杂志,2000,16(3):110-112.

    [34]

    中华医学会心血管病学分会,中华心血管病杂志编委会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.

    [35]

    Matsumura Y,Takata J,Kitaoka H,et al.Long-term prognosis of dilated cardiomyopathy revisited:an improvement in survival over the past 20 years[J].Circ J,2006,70(4):376-383.

    [36]

    Kubo T,Matsumura Y,Kitaoka H,et al.Improvement in prognosis of dilated cardiomyopathy in the elderly over the past 20 years[J].J Cardiol,2008,52(2):111-117.

    [37]

    CONSENSUS Trial Study Group.Effects of enalapril on mortality in severe congestive heart failure:results of the Cooperative Noorth Scandinavian Enalapril Survival Study (CONENSUS)[J].N Engl J Med,1987,316(23):1429-1435.

    [38]

    SOLVD Investigators,Yusuf S,Pitt B,et al.Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure[J].N Engl J Med,1991,325(5):293-302.

    [39]

    Pfeffer MA,Braunwald E,Moyé LA,et al.Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction.Results of the survival and ventricular enlargement trial.The SAVE Investigators[J].N Engl J Med,1992,327(10):669-677.

    [40]

    Maggioni AP,Anand I,Gottlieb SO,et al.Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors[J].J Am Coll Cardiol,2002,40(8):1414-1421.

    [41]

    McMurray JJ,Ostergren J,Swedberg K,et al.Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors:the CHARM-Added trial[J].Lancet,2003,362(9386):767-771.

    [42]

    Konstam MA,Neaton JD,Dickstein K,et al.Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study):a randomised,double-blind trial[J].Lancet,2009,374(9704):1840-1848.

    [43]

    McMurray JJ,Packer M,Desai AS,et al.Angiotensin-neprilysin inhibition versus enalapril in heart failure[J].N Engl J Med,2014,371:993-1004.

    [44]

    CIBIS-Ⅱ Investigators and Committecs.The Cardiac Insufficiency Bisoprolol Study Ⅱ (CIBIS-Ⅱ):a randomised trial[J].Lancet,1999,353(9146):9-13.

    [45]

    MERIT-HF Study Group.Effect of metoprolol CR/XL in chronic heart failure:Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure(MERIT-HF)[J].Lancet,1999,12,353(9169):2001-2007.

    [46]

    Packer M,Fowler MB,Roecker EB,et al.Effect of carvedilol on the morbidity of patients with severe chronic heart failure:results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study[J].Circulation,2002,106(17):2194-2199.

    [47]

    Pitt B,Zannad F,Remme WJ,et al.The effect of spironolactone on morbidity and mortality in patients with severe heart failure.Randomized Aldactone Evaluation Study Investigators[J].N Engl J Med,1999,341(10):709-717.

    [48]

    Pitt B,Remme W,Zannad F,et al.Eplerenone,a selective aldosterone blocker,in patients with left ventricular dysfunction after myocardial infarction[J].N Engl J Med,2003,348(14):1309-1321.

    [49]

    Li X,Zhang J,Huang J,et al.A multicenter,randomized,double-blind,parallel-group,placebo-controlled study of the effects of qili qiangxin capsules in patients with chronic heart failure[J].J Am Coll Cardiol,2013,62(12):1065-1072.

    [50]

    Liao YH,Cheng LX,Tu YS,et al.Mechanism of anti-β-adrenoceptor antibody mediated myocardial damage in dilated cardiomyopathy[J].J Tongji Med Univ,1997,17(1):5-8.

    [51]

    Nagatomo Y,Yoshikawa T,Okamoto H,et al.Presence of autoantibody directed against b1-adrenergic receptors is associated with amelioration of cardiac function in response to carvedilol:Japanese Chronic Heart Failure (J-CHF) Study[J].J Cardiac Fail,2015,21(3):198-207.

    [52]

    Waagstein F,Bristow MR,Swedberg K,et al.Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy.Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group[J].Lancet,1993,342(8885):1441-1446.

    [53]

    Figulla HR,Gietzen F,Zeymer U,et al.Diltiazem improves cardiac function and exercise capacity in patients with idiopathic dilated cardiomyopathy.Results of the Diltiazem in Dilated Cardiomyopathy Trial[J].Circulation,1996,94(3):346-352.

    [54]

    Liao YH.Interventional study of diltiazem in dilated cardiomyopathy:a report of multiple centre clinical trial in China.Chinese cooperative group of diltiazem intervention trial in dilated cardiomyopathy[J].Int J Cardiol,1998,64(1):25-30.

    [55]

    魏晶晶,袁璟,汪朝晖,等.β受体阻滞剂/地尔硫治疗扩张型心肌病患者病死率的Meta分析[J].临床心血管病杂志,2017,33(2):128-132.

    [56]

    Wallukat G,Reinke P,Dörffel WV,et al.Removal of autoantibodies in dilated cardiomyopathy by immunoadsorption[J].Int J Cardiol,1996,54(2):191-195.

    [57]

    Ameling S,Herda LR,Hammer E,et al.Myocardial gene expression profiles and cardiodepressant autoantibodies predict response of patients with dilated cardiomyopathy to immunoadsorption therapy[J].Eur Heart J,2013,34(9):666-675.

    [58]

    Yoshikawa T,Baba A,Akaishi M,et al.Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column-A prospective,multicenter,randomized,within-patient and parallel-group comparative study to evaluate efficacy and safety[J].J Clin Apher,2016,31(6):535-544.

    [59]

    Schwartz J,Padmanabhan A,Aqui N,et al.Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis:The Seventh Special Issue[J].J Clin Apher,2016.31(3):149-162.

    [60]

    廖玉华,程翔,袁璟.心血管病免疫学治疗路在何方[J].临床心血管病杂志,2018,34(1):1-4.

    [61]

    杨英珍,陈瑞珍,张寄南,等.中西医结合治疗扩张型心肌病的临床观察[J].中国中西医结合杂志,2001,21(4):254-256.

    [62]

    Zhu YS,Li YL,Ju JQ,et al.Oral chinese herbal medicine for treatment of dilated cardiomyopathy:A systematic review and Meta-analysis[J].Evid Based Complement Alternat Med,2016,2016:1819794.

    [63]

    Zhang L,Lu Y,Jiang H,et al.Additional use of trimetazidine in patients with chronic heart failure[J].J Am Coll Cardiol,2012,59(10):913-922.

    [64]

    Gao D,Ning N,Niu X,et al.Trimetazidine:a meta-analysis of randomized controlled trials in heart failure[J].Heart,2011,97(4):278-286.

    [65]

    Grajek S,Michalak M.The effect of trimetazidine added to pharmacological treatment on all-cause mortality in patients with systolic heart failure[J].Cardiology,2015,131(1):22-29.

    [66]

    Mortensen SA,Rosenfeldt F,Kumar A,et al.The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure:results from Q-SYMBIO:a randomized double-blind trial[J].JACC Heart Fail,2014,2(6):641-649.

    [67]

    Bart BA,Goldsmith SR,Lee KL,et al.Ultrafiltration in decompensated heart failure with cardiorenal syndrome[J].N Engl J Med,2012,367(24):2296-2304.

    [68]

    李双双,李东泽,马依彤.血液超滤治疗急性心力衰竭综合征的Meta分析[J].重庆医学,2015,44(24):3376-3380.

    [69]

    胡大一,冯新庆.2015心衰超滤脱水装置临床应用中国专家建议[J].中国心血管病研究,2015,13(12):1104,1118.

    [70]

    心力衰竭超滤治疗专家组.心力衰竭超滤治疗建议[J].中华心血管病杂志,2016,44(6):477-482.

    [71]

    Mehra MR,Canter CE,Hannan MM,et al.The 2016 international society for heart lung transplantation listing criteria for heart transplantation:A 10-year update[J].J Heart Lung Transplant,2016,35(1):1-23.

    [72]

    Mcnally EM,Golbus JR,Puckelwartz MJ.Genetic mutations and mechanisms in dilated cardiomyopathy[J].J Clin Invest,2013,123(1):19-26.

    [73]

    方位,罗蓉,李小平.家族性扩张型心肌病常见突变的研究进展[J].医学综述,2016,22(18):3537-3540.

    [74]

    Kawada T,Nakazawa M,Nakauchi S,et al.Rescue of hereditary form of dilated cardiomyopathy by rAAV-mediated somatic gene therapy:amelioration of morphological findings,sarcolemmal permeability,cardiac performances,and the prognosis of TO-2 hamsters[J].Proc Natl Acad Sci U S A,2002,99(2):901-906.

    [75]

    Komamura K,Tatsumi R,Miyazaki J,et al.Treatment of dilated cardiomyopathy with electroporation of hepatocyte growth factor gene into skeletal muscle[J].Hypertension,2004,44(3):365-371.

    [76]

    Goser S,Ottl R,Brodner A,et al.Critical role for monocyte chemoattractant protein-1 and macrophage inflammatory protein-1alpha in induction of experimental autoimmune myocarditis and effective anti-monocyte chemoattractant protein-1 gene therapy[J].Circulation,2005,112(22):3400-3407.

    [77]

    Melacini P,Basso C,Angelini A,et al.Clinicopathological profiles of progressive heart failure in hypertrophic cardiomyopathy[J].European Heart J,2010,31(17):2111-2123.

    [78]

    Maisch B.Alcoholic cardiomyopathy The result of dosage and individual predisposition[J].Herz,2016,41(6):484-493.

    [79]

    Walsh CR,Larson MG,Evans JC,et al.Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study[J].Ann Intern Med,2002,136(3):181-191.

    [80]

    Fairweather D,Cooper LT Jr,Blauwet LA.Sex and gender differences in myocarditis and dilated cardiomyopathy[J].Curr Probl Cardiol,2013,38(1):7-46.

    [81]

    Li W,Li H,Long Y.Clinical characteristics and long-term predictors of persistent left ventricular systolic dysfunction in peripartum cardiomyopathy[J].Can J Cardiol,2016,32(3):362-368.

    [82]

    Hilfiker-Kleiner D,Haghikia A,Nonhoff J,et al.Peripartum cardiomyopathy:current management and future perspectives[J].Eur Heart J,2015,36(18):1090-1097.

    [83]

    Bozkurt B,Colvin M,Cook J,et al.Current diagnostic and treatment strategies for specific dilated cardiomyopathies:A scientific statement from the American Heart Association[J].Circulation,2016,134(23):e579-e646.

    [84]

    Deshmukh PM,Krishnamani R,Romanyshyn M,et al.Association of angiotensin converting enzyme gene polymorphism with tachycardia cardiomyopathy[J].Int J Mol Med,2004,13(3):455-458.

    [85]

    Shinbane JS,Wood MA,Jensen DN,et al.Tachycardia-induced cardiomyopathy:a review of animal models and clinical studies[J].J Am Coll Cardiol,1997,29(4):709-715.

    [86]

    Fenelon G,Wijns W,Andries E,et al.Tachycardiomyopathy:mechanisms and clinical implications[J].Pacing Clin Electrophysiol,1996,19(1):95-106.

    [87]

    Gopinathannair R,Etheridge SP,Marchlinski FE,et al.Arrhythmia-induced cardiomyopathies:mechanisms,recognition,and management[J].J Am Coll Cardiol,2015,66(15):1714-1728.

    [88]

    Malcom J,Arnold O,Howlett JG,et al.Canadian Cardiovascular Society Consensus Conference guidelines on heart failure——2008 update:best practices for the transition of care of heart failure patients,and the recognition,investigation and treatment of cardiomyopathies[J].Can J Cardiol,2008,24(1):21-40.

    [89]

    Watanabe H,Okamura K,Chinushi M,et al.Clinical characteristics,treatment,and outcome of tachycardia induced cardiomyopathy[J].Int Heart J,2008,49(1):39-47.

    [90]

    Nerheim P,Birger-Botkin S,Piracha L,et al.Heart failure and sudden death in patients with tachycardia-induced cardiomyopathy and recurrent tachycardia[J].Circulation,2004,110(3):247-252.

    [91]

    Li Q,Liu M,Hou J,et al.The prevalence of Keshan disease in China[J].Int J Cardiol,2013,168(2):1121-1126.

    [92]

    赵德超,梁雨亭,田野.克山病的诊治进展[J].临床心血管病杂志,2017,33(4):300-303.

    [93]

    Yancy CW,Jessup M,Bozkurt B,et al.2013 ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,62(16):e147-239.

    [94]

    O'Connor CM,Whellan DJ,Lee KL,et al.Efficacy and safety of exercise training in patients with chronic heart failure:HF-ACTION randomized controlled trial[J].JAMA,2009,301(14):1439-1450.

    [95]

    Piepoli MF,Corrà U,Benzer W,et al.Secondary prevention through cardiac rehabilitation:from knowledge to implementation.A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation[J].Eur J Cardiovasc Prev Rehabil,2010,17(1):1-17.

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