在心力衰竭中使用个性化加速生理步调的临床结果:myPACE试验的后续研究
Margaret Infeld1, Jamie Cyr2, Alexandra E Novelli3
1Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
JAMA cardiology
|August 27, 2025
概括
个性化加速节拍可以减少心脏衰竭的不良事件,其中包括心脏节拍器 (HFpEF). 需要进一步的试验来证实这些发现.
科学领域:
- 心脏病学
- 医疗器械
- 临床试验
背景情况:
- 心脏衰竭与保存的喷射分数 (HFpEF) 构成一个重要的临床挑战.
- 在HFpEF患者中使用生理节拍器,但最佳节拍率仍有争议.
- 对于所有HFpEF患者来说,标准的节奏率可能不足.
研究的目的:
- 在使用心脏起器的HFpEF患者中,比较个性化加速节奏和常规护理之间的不良事件累积情况.
- 评估个性化节奏策略在改善临床结果方面的有效性.
主要方法:
- 在 myPACE 随机临床试验的观察扩展.
- 患有 B 或 C 阶段 HFpEF 且已有生理心脏起器的 100 名患者.
- 随访时间长达4年,比较个性化加速节奏 (myPACE) 与60次/分钟 (常规护理).
主要成果:
- 治疗意向 (ITT) 分析显示myPACE的事件累积趋势较慢 (P=0. 07).
- 每项方案 (PP) 分析显示myPACE的不良事件累积显著减缓 (P=0. 01) 和无事件存活时间更长 (P=0. 02).
- 结果主要是由于心力衰竭相关事件的减少.
结论:
- 个性化加速生理步调显示出降低HFpEF患者不良临床事件的潜力.
- 与标准的每分钟60拍节奏相比,每项方案分析显示了显著的益处.
- 结果是产生假设的,需要在更大的多中心试验中得到确认.
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