Pericardiectomy to Treat Heart Failure With Preserved Ejection Fraction: Unrestrained Enthusiasm?
Pericardiectomy to Treat Heart Failure With Preserved Ejection Fraction: Unrestrained Enthusiasm?
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心包切除术治疗保留射血分数的心力衰竭：无拘无束的热情？
DOI：
10.1161/circheartfailure.117.003971
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
LeWinter,MartinM
中科院分区：
文献类型：
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作者：
LeWinter,MartinM
2勒温式心包切除术充盈充盈压力。几年前，我们在一个心脏明显扩张的模型中证实了这一预测，因为系统性动静脉瘘，我们观察到在心脏逐渐扩大后，心包PVR右移并比正常平坦。22、23这与心包组织硬度的变化有关。19由于心包PVR变平，在慢性心脏扩张过程中，归一化为心脏容量的抑制作用实际上是减弱的。23心包在心脏扩张过程中的这种行为可能也解释了这样一个事实，即大量缓慢积累的心包积液可以很好地耐受，而小得多的快速积聚的积液可能会导致心脏压塞。最后，在正常的大型动物身上进行的更多研究表明，心包切除术可以最大限度地改善运动时的心血管功能。28、29这可能反映了利用弗兰克-斯塔林关系的能力有所改善。综上所述，这些观察表明，在保留心包抑制作用的情况下，心包切除术可以降低HFpEF患者的充盈压并改善心功能。
2 LeWinter Pericardiectomy for HFpEF filling pressures. Years ago, we confirmed this prediction in a model of marked cardiac dilatation because of a systemic arteriovenous fistula where we observed that the pericardial PVR is shifted to the right and flatter than normal after the heart gradually enlarges. 22, 23 This was associated with changes in the stiffness of the pericardial tissue. 19 Because of flattening of the pericardial PVR, the restraining effect normalized to cardiac volume is actually reduced during chronic cardiac dilatation. 23 This behavior of the pericardium during cardiac dilatation presumably also accounts for the fact that large, slowly accumulating pericardial effusions are well tolerated, whereas much smaller, rapidly accumulating effusions can cause cardiac tamponade. Finally, additional studies in normal large animals have shown that pericardiectomy improves maximal cardiovascular performance during exercise. 28, 29 This likely reflects an improved ability to use the Frank–Starling relation. Taken together, these observations suggest that pericardiectomy might reduce filling pressures and improve cardiac performance in HFpEF patients, provided that the pericardial restraining effect is retained.