心房分流术研究进展及启示
The progress and implications of interatrial shunt
常三帅 1刘新民 1姜正明 1马为 2董建增 3宋光远1
作者信息
- 1. 首都医科大学附属北京安贞医院心脏瓣膜病介入中心国家心血管病临床医学研究中心,北京 100029
- 2. 北京大学第一医院心内科,北京 100034
- 3. 首都医科大学附属北京安贞医院心力衰竭中心国家心血管病临床医学研究中心,北京 100029
- 折叠
摘要
虽然心力衰竭(心衰)的药物和器械治疗均取得了较大进步,但心衰患者整体仍预后较差.心衰的血流动力学异常表现为左心房压升高和肺淤血,既往研究表明降低左心房压可改善心衰患者的症状和预后,因此左心系统超负荷可能是心衰治疗的一个潜在靶点.心房分流术旨在制造一定程度稳定可控的左向右心内分流,将心衰患者失代偿的左心容量和压力负荷恢复至代偿状态,从而改善心衰症状及预后,目前全球范围内仍处于临床研究阶段,已有数据表明心房分流术可降低心衰患者静息或运动时左心房压,改善肺淤血,提高患者活动耐量和临床心功能,但尚无研究证实其可以改善心衰再入院和死亡等临床终点事件.未来的研究重点在于筛选能从心房分流术中获益的心衰患者,明确心衰病因、右心功能和肺血管阻力可逆性的评估以及依据射血分数的心衰分型可能是筛选患者的关键因素.
Abstract
Despite significant advancements in treatments for heart failure,the overall prognosis for patients remains poor.Hemodynamic abnormalities in heart failure manifest as elevated left atrial pressure and pulmonary congestion.Previous studies have shown that reducing left atrial pressure can improve symptoms and prognosis for heart failure patients,suggesting that left-sided heart overload may be a potential target for heart failure treatment.Atrial shunting procedures aim to create a stable and controlled left-to-right intracardiac shunt,restoring the decompensated left heart volume and pressure load in heart failure patients to a compensatory state,thereby improving heart failure symptoms and prognosis.Currently,this treatment is still in the clinical research stage globally.Existing data indicate that atrial shunting procedures can lower left atrial pressure at rest or during exercise in heart failure patients,improve pulmonary congestion,enhance patients'exercise tolerance,and clinical cardiac function.However,no studies have yet confirmed that it can improve clinical endpoints such as rehospitalization and mortality due to heart failure.Future research will focus on identifying heart failure patients who may benefit from atrial shunting,with assessments of heart failure etiology,right heart function,and reversibility of pulmonary vascular resistance,as well as heart failure classification based on ejection fraction,serving as potential key factors for patient selection.
关键词
心力衰竭/心房分流/左心房压/肺毛细血管楔压/肺动脉压Key words
Heart failure/Inter-atrial shunt/Left atrial pressure/Pulmonary capillary wedge pressure/Pulmonary artery pressure引用本文复制引用
出版年
2024
NETL
NSTL
万方数据