Left ventricular assist device and drug therapy for the reversal of heart failure
Left ventricular assist device and drug therapy for the reversal of heart failure
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DOI：
10.1056/nejmoa053063
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发表时间：
2006-11-02
影响因子：
158.5
通讯作者：
Yacoub, Magdi H.
中科院分区：
文献类型：
--
作者：
Birks, Emma J.;Tansley, Patrick D.;Yacoub, Magdi H.
背景：据报道，在严重心力衰竭患者中，使用左心室辅助装置延长心肌负荷可导致少数患者在不同时期内心肌恢复。增加心肌恢复的频率和持久性可以减少或推迟后续心脏移植的需要。方法：我们招募了 15 名因非缺血性心肌病而患有严重心力衰竭且没有活动性心肌炎组织学证据的患者。所有患者的心输出量均明显减少，并正在接受正性肌力药物治疗。患者接受左心室辅助装置植入，并接受赖诺普利、卡维地洛、螺内酯和氯沙坦治疗以增强逆重构。一旦左心室扩大消退，就给予 β(sub 2)-肾上腺素能受体激动剂克仑特罗以预防心肌萎缩。 结果：15 名患者中有 11 名心肌恢复充分，可以接受左心室辅助装置的移植，平均 (+/-SD) 为植入装置后 320+/-186 天。一名患者在摘除后24小时因顽固性心律失常死亡；另一位患者在移植后 27 个月死于肺癌。存活患者在移植后 1 年和 4 年的累积无复发性心力衰竭率分别为 100% 和 88.9%。根据明尼苏达心力衰竭生活问卷评分评估，3 年时的生活质量几乎正常。移植后 59 个月，平均左心室射血分数为 64+/-12%，平均左心室舒张末期直径为 59.4+/-12.1 mm，平均左心室收缩末期直径为 42.5+/-13.2 mm，运动时平均最大摄氧量为每公斤体重每分钟 26.3+/-6.0 ml。 结论：在单中心研究中，我们发现，通过使用左心室辅助装置和特定的药物治疗方案，选定的患者可以实现继发于非缺血性心肌病的严重心力衰竭的持续逆转。
BACKGROUND:In patients with severe heart failure, prolonged unloading of the myocardium with the use of a left ventricular assist device has been reported to lead to myocardial recovery in small numbers of patients for varying periods of time. Increasing the frequency and durability of myocardial recovery could reduce or postpone the need for subsequent heart transplantation.METHODS:We enrolled 15 patients with severe heart failure due to nonischemic cardiomyopathy and with no histologic evidence of active myocarditis. All had markedly reduced cardiac output and were receiving inotropes. The patients underwent implantation of left ventricular assist devices and were treated with lisinopril, carvedilol, spironolactone, and losartan to enhance reverse remodeling. Once regression of left ventricular enlargement had been achieved, the (beta)(sub 2)-adrenergic-receptor agonist clenbuterol was administered to prevent myocardial atrophy.RESULTS:Eleven of the 15 patients had sufficient myocardial recovery to undergo explantation of the left ventricular assist device a mean (+/-SD) of 320+/-186 days after implantation of the device. One patient died of intractable arrhythmias 24 hours after explantation; another died of carcinoma of the lung 27 months after explantation. The cumulative rate of freedom from recurrent heart failure among the surviving patients was 100% and 88.9% 1 and 4 years after explantation, respectively. The quality of life as assessed by the Minnesota Living with Heart Failure Questionnaire score at 3 years was nearly normal. Fifty-nine months after explantation, the mean left ventricular ejection fraction was 64+/-12%, the mean left ventricular end-diastolic diameter was 59.4+/-12.1 mm, the mean left ventricular end-systolic diameter was 42.5+/-13.2 mm, and the mean maximal oxygen uptake with exercise was 26.3+/-6.0 ml per kilogram of body weight per minute.CONCLUSIONS:In this single-center study, we found that sustained reversal of severe heart failure secondary to nonischemic cardiomyopathy could be achieved in selected patients with the use of a left ventricular assist device and a specific pharmacologic regimen.