International Circulation: How will these initial indicators affect treatment?
　　Dr Anker: In heart failure， there are several therapies that adversely impact kidney function， so dose adjustment is important. There are several treatments that are restricted to certain degrees of cardiac dysfunction; if the ejection fraction is less than 25%， 35%， or 45% then there is a selection of drugs and devices for these patients. Therapy can be modified in terms of “yes” and “no” and in terms of dose adjustments. These choices rely on the biomarkers and the clinical experience of the treating physician.
　　《国际循环》：这些初期的生物标志物对治疗有什么影响？
　　Anker教授：在心力衰竭方面，有些治疗对肾功能有不良影响，因此调整治疗药物的剂量是重要的。如果射血分数低于25%或35%，这些患者的治疗药物和器械要有所选择。某项治疗“可以选择”或“不可以选择”或剂量进行调整，可基于生物标志物和医生的临床治疗经验来确定。
　　International Circulation: Are patients with heart failure and significantly reduced kidney function contraindicated for the use of ACE inhibitors and Angiotensin Receptor Blocker (ARBs)?
　　Dr Anker: It depends on how much is meant by significantly impaired. When the GFR is above 30 mL/min， I would say ACE inhibitors and ARB treatment is still acceptable. Below that， you have to be careful and assess all the co-morbities of the patient. In this case， a lower dose for that patient would be appropriate.
　　《国际循环》：肾功能明显障碍的心力衰竭患者是否禁忌应用ACEI和ARB？
　　Anker教授：这取决于肾功能明显障碍的定义是什么。当GFR> 30 ml/min时，我认为ACEI和ARB治疗还是可以接受的。如果GFR < 30 ml/min，就得谨慎些，需评价患者并存疾病。此时，给予更低剂量的治疗药物是合适的。