血液动力学导向心力衰竭治疗 (GUIDE-HF):一个随机对照试验
JoAnn Lindenfeld1, Michael R Zile2, Akshay S Desai3
1Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
Lancet (London, England)
|August 30, 2021
概括
对于心力衰竭的远程肺动脉压力监测没有显著降低总体死亡率或心力衰竭事件. 然而,在COVID-19之前的分析表明,降低心力衰竭住院的可能性有好处.
科学领域:
- 心脏病学
- 医疗器械
- 临床试验
背景情况:
- 之前的研究表明,血液动力学引导的治疗减少了NYHAIII类患者的心力衰竭住院.
- 在NYHAII- IV类患者和尿素水平升高但没有近期住院的患者中存在不确定性.
研究的目的:
- 评估远程肺动脉压力监测是否可以减少NYHAII-IV类心力衰竭事件和死亡率.
- 评估高尿素水平但没有最近入院的心力衰竭的患者的疗效.
主要方法:
- 多中心,单盲,随机试验 (GUIDE- HF) 涉及1022名慢性心力衰竭患者.
- 患者通过肺动脉压力监测或通常的护理接受血液动力学指导的治疗.
- 主要终点:12个月内所有原因死亡率和总心力衰竭事件的组合.
主要成果:
- 总体分析:主要终点没有显著降低 (HR 0.88, p=0. 16).
- 在COVID-19前的分析:主要事件的显著减少 (HR 0.81, p=0.049) 和心力衰竭事件 (HR 0.76, p=0.014).
- 在COVID-19期间:初级终点差异减少;两组之间没有显著差异 (HR 1.11, p=0.53).
结论:
- 在整个研究群体中,血动力学引导的治疗没有显著降低复合终点.
- 在COVID-19前的一项分析表明,由于心力衰竭住院次减少,这可能有所益处.
- COVID-19 疫情似乎影响了病例发生率和观察到的治疗效果.
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