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优化前期心力衰竭的门诊患者的分组:复苏的2年结果
Keith D Aaronson1, Garrick C Stewart2, Lynne W Stevenson3
1Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
JACC. Heart failure
|July 6, 2024
概括
接受指导医学治疗 (GDMT) 的高级心力衰竭患者表现出强大的生存率和生活质量,挑战了在这个群体中更早植入左心室辅助器件 (LVAD) 的需要.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭管理的管理
- 机械循环支持 机械循环支持
背景情况:
- 左心室辅助装置 (LVAD) 的使用在不需要内药的晚期心力衰竭 (HF) 患者中不常见.
- 在将LVAD与医疗治疗进行比较之前,了解接受最佳指导方针导向医疗疗 (GDMT) 的门诊先发性缩性HF患者的临床过程至关重要.
研究的目的:
- 评估晚期缩性HF接受最佳GDMT的门诊患者的临床轨迹和结果.
- 关于早期LVAD植入与持续医疗管理的决定.
主要方法:
- 在REVIVAL注册中,在21个LVAD中心注册了400名先进的门诊性缩性HF患者,至少有一个死亡风险标志物.
- 患者被跟踪2年或直到死亡,持久心室辅助装置植入或紧急移植.
- 评估了临床结果和与健康有关的生活质量.
主要成果:
- 综合初级结局发生在1年后的22%和2年后的37%中;单单死亡发生在8%和16%中.
- 2年生存的患者保持了GDMT强度,并报告生活质量没有下降.
- 基线特征包括平均喷射率为21%,平均6分钟步行距离为341米.
结论:
- 专门中心的结构化随访有助于对高级HF患者进行治疗.
- 需要改进的策略,以防止患者的一个子集的死亡.
- 在REVIVAL患者中没有选择VAD或移植的强大生存率和患者报告的结果质疑早期LVAD植入的倡导.
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