对于心力衰竭的心房转移疗法:一个更新
Vikrant Jagadeesan1, William A Gray2, Sanjiv J Shah3,4
1West Virginia Heart and Vascular Institute, West Virginia School of Medicine, Morgantown, West Virginia.
概括
过导管心房分流的目的是降低心力衰竭 (HF) 治疗的左心房压力. 虽然一些研究在特定的患者群体中显示出有希望的结果,但关键试验表明需要进一步研究以确定最佳的设备设计和患者选择.
科学领域:
- 心血管医学 心血管医学
- 医疗器械 医疗器械
- 心脏衰竭研究研究
背景情况:
- 透导管心房转移是一种针对心力衰竭 (HF) 的新型治疗方法.
- 这些设备旨在通过在左心房和右心房之间创建一个分流来降低左心房 (LA) 压力.
- 十多年的开发已经导致了几种设备和正在进行的关键随机临床试验 (RCT).
研究的目的:
- 为提供对心力衰竭的心房分流治疗方法的全面审查.
- 描述当前的HF治疗方法,心房分流开发的理由,以及设备设计.
- 讨论积累的证据,未解答的问题,以及该领域的未来考虑.
主要方法:
- 审查关于心房分流器的现有文献和临床试验数据.
- 分析机械和关键随机临床试验 (RCT) 的结果.
- 确定可能受益于心房分流疗法的患者子组.
主要成果:
- 已报告了两个模拟控制的RCT,用于心脏关装置在HF中,EF≥40%.
- 一个机理性RCT显示运动LA压力降低,而一个关键RCT是中性的.
- 对关键RCT的子组分析确定了基于肺血管抵抗和缺乏心律控制装置的潜在响应者.
结论:
- 耳前突变代表了对心力衰竭的潜在创新疗法.
- 最佳的器械设计,程序方法和HF患者表型的益处尚未确定.
- 进一步的研究和正在进行的RCT对于确认发现和指导临床应用至关重要.
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