在心力衰竭中进行心房移除,减少与保留射出分数:系统性审查和元分析
Alireza Oraii1, William F McIntyre1,2, Ratika Parkash3
1Population Health Research Institute, Hamilton, Ontario, Canada.
JAMA cardiology
|April 24, 2024
概括
对于心房动 (AF) 的导管切除显著减少心力衰竭 (HF) 事件在心力衰竭的患者心脏衰竭与减少喷射率 (HFrEF). 然而,它对心力衰竭患者没有显著的益处,心力衰竭患者的喷射分数保存 (HFpEF).
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏衰竭研究研究
背景情况:
- 对心房动 (AF) 的导管切除已被确立为减少心力衰竭 (HF) 住院和心力衰竭患者的死亡率.
- 导管切除在患有心力衰竭和保留射出分数 (HFpEF) 的患者中的疗效仍然不确定,需要进一步调查基于HF表型的HF相关结果.
研究的目的:
- 评估导管切除与AF和HF相关结果之间的关联,特别是检查HFrEF和HFpEF表型之间的差异.
- 为了确定导管切除是否在AF和HF患者中提供超越常规速率或节律控制的好处.
主要方法:
- 在MEDLINE,Embase和Cochrane中央数据库中进行了系统的文献搜索,直到2023年9月.
- 包括并行组随机临床试验 (RCT),将导管切除与HF患者 (NYHAII级或以上) 的常规疗法进行比较. 用随机效应模型提取和合成数据,用于子组分析的相互作用P值.
主要成果:
- 分析了12个RCT,包括2465名参与者 (1552名HFrEF,913名HFpEF).
- 导管切除在HFrEF (RR,0.59;95% CI,0.48-0.72) 中显著减少了HF事件,但在HFpEF中没有 (RR,0.93;95% CI,0.65-1.32;P相互作用=0.03).
- 对心血管和全因死亡率观察到类似的趋势,HFrEF显著减少,但HFpEF没有.
结论:
- 对AF的导管切除与HFrEF患者中HF事件的风险降低有关.
- 该研究发现,在患有HFpEF的患者中,导管切除对AF的益处有限或不存在.
- 目前正在进行的试验预计将进一步了解导管切除在HFpEF背景下管理AF中的作用.
相关概念视频
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
422
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
422
01:17Pathophysiology of Heart Failure
1.6K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.6K
01:22Heart Failure Drugs: β-Blockers
337
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
337