改进HFpEF的心房间隔离疗法:从关键随机试验和新兴方向中吸取教训
Dylan J Gyberg1, Jan Komtebedde2, Uma Mylavarapu3
1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Minnesota Medical School, Minneapolis, Minnesota.
Journal of cardiac failure
|December 1, 2025
概括
间分流可能有利于选择心力衰竭与保存喷射小部分 (HFpEF) 患者. 仔细选择患者,专注于没有肺血管疾病的患者,对于积极的结果至关重要,正如试验比较所示.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 临床试验 临床试验
背景情况:
- 保存喷射分数 (HFpEF) 的心力衰竭是一个重大的临床挑战,治疗选择有限.
- 升高的左心房压力是HFpEF症状和进展的关键因素,代表了一个关键的治疗标.
- 人们正在研究心房间间的分流作为一种新的方法来降低左心房压力并改善HFpEF结果.
研究的目的:
- 为了比较REDUCE LAP-HF II和RELIEVE-HF试验的设计和结果,这些试验调查了HFpEF中的心脏间位.
- 探索这两个主要试验的看似相互矛盾的结果的潜在一致性.
- 突出详细的患者表型的重要性,以识别对心房间间隔静脉治疗的响应者.
主要方法:
- 两项随机对照试验 (REDUCE LAP-HF II和RELIEVE-HF) 对HFpEF的腹腔间转移进行了比较分析.
- 对患者子组的检查,重点关注诸如射出分数,肺血管疾病和心律管理装置等特征.
- 在表型化方法中包括侵入性运动血液动力学和心声回声数据.
主要成果:
- REDUCE LAP-HF II确定了一个响应子组 (EF>40%,没有潜在的肺血管疾病或器械),具有显著的临床益处.
- 在REDUCE LAP-HF II中没有反应的人和在RELIEVE-HF中患者 (EF>40%) 显示出更糟糕的结局,共享诸如高级心声学异常和升高的肺血管抵抗等特征.
- 这些发现表明,看似相互矛盾的试验结果可以通过仔细的患者选择标准来协调.
结论:
- 在精心挑选的HFpEF群体中,心房间间间的分流可能为临床效益提供.
- 详细的患者表型,包括侵入性血液动力学,对于优化心房间间间的分流疗法的疗效至关重要.
- 精细的患者选择策略对于正在进行和未来的试验至关重要,例如RESPONDER-HF,旨在改善HFpEF和HF的结果,轻微减少EF.
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