针对系统性右心室患者的新疗法
Guillermo Agorrody1, Danielle Massarella2, Rafael Alonso-Gonzalez2
1Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Departamento de Fisiopatologia, Hospital de Clinicas, Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay; Unidad de Cardiopatías Congénitas, Centro Cardiológico Americano, Montevideo, Uruguay. Electronic address: https://twitter.com/guilleagorrody.
在患有先天性心脏病的成年人中,系统性右心室衰竭带来了挑战. 新疗法,包括新药和先进的治疗方法,有望改善这些复杂患者的治疗结果.
科学领域:
- 心脏病学 心脏病学
- 成年人的先天性心脏病
- 心血管生理学心血管生理学
背景情况:
- 系统性右心室 (RV) 功能障碍是先天性心脏病 (CHD) 的关键预后因素,特别是在大动脉转移 (TGA) 后心房切换和先天性纠正TGA (ccTGA) 的患者中.
- 在这些条件下,慢性压力负荷会导致RV结构,机械和电气的不适应,往往导致心力衰竭.
- 在成人心血管疾病中,系统性RV衰竭的有效管理策略对于改善患者预后至关重要.
研究的目的:
- 审查和讨论新的治疗方法来管理成人心脏病患者的系统性RV衰竭.
- 评估当前和新兴的药理学,基于设备和先进的心力衰竭疗法的疗效.
- 突出需要个性化治疗策略,根据患者个体特征量身定制.
主要方法:
- 审查现有的关于治疗系统性RV功能障碍的治疗干预措施的文献. 成年人CHD.
- 分析与传统心力衰竭药物相关的结果.
- 评估新兴的药理学药物 (ARNI,SGLT2抑制剂),心脏再同步治疗 (CRT),机械循环支持 (MCS) 和心脏移植 (HTx).
主要成果:
- 传统的心力衰竭药物在全身RV衰竭中表现出可变的疗效.
- 较新的药物,如血管激素受体-尼普利辛抑制剂 (RNAI) 和-葡萄糖共传输体2抑制剂 (SGLT2i),显示出改善RV重塑和功能的潜力.
- 慢性心力疗法可以使特定患者受益,而MCS和HTx是心力衰竭晚期的有效选择,报告的长期结果有利.
结论:
- 成年人心血管疾病系统性RV衰竭的管理需要个性化的方法,考虑到独特的患者生理学和解剖学.
- 新型药理学和基于设备的疗法比传统疗法提供了潜在的改善,传统疗法已经显示出有限的疗效.
- 进一步的研究是必不可少的,以完善现有策略,并确定新的治疗目标,以此种人群的系统性RV失败.
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