Benefits of Neurohormonal Therapy in Patients With Continuous-Flow Left Ventricular Assist Devices.
Benefits of Neurohormonal Therapy in Patients With Continuous-Flow Left Ventricular Assist Devices.
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DOI：
10.1097/mat.0000000000001022
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发表时间：
2020-04
期刊：
影响因子：
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通讯作者：
Thohan V
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文献类型：
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作者：
Yousefzai R;Brambatti M;Tran HA;Pedersen R;Braun OÖ;Baykaner T;Ghashghaei R;Sulemanjee NZ;Cheema OM;Rappelt M;Baeza C;Alkhayyat A;Shi Y;Pretorius V;Greenberg B;Adler E;Thohan V
左心室辅助装置（LVAD）显著改善了晚期心力衰竭患者的短期结局。虽然神经激素阻滞（NHB）是射血分数降低的心力衰竭患者治疗的基础，但其在LVAD置入后的效果尚未确定。我们回顾了2006年1月至2015年9月在美国两家机构接受初次LVAD植入的307例患者的病历。患者在LVAD植入后至少随访2年，或直至再灌注、心脏移植或死亡。采用按中心分层的考克斯回归分析评估与死亡率的相关性。NHB使用被视为时间依赖性预测因素。逐步选择表明用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗（ACEI/ARB）（HR=0.53（0.30-0.95），P = 0.03），植入时的年龄（HR = 1.28（1.05-1.56）/十年，P = 0.02），植入后住院时间（HR = 1.16（1.11-1.21）/周，P < 0.01）和INTERMACS评分1或2（HR = 1.86（1.17-2.97），P < 0.01）是死亡率的独立预测因素。在这项大型回顾性研究中，ACEI或ARB治疗是与LVAD置入后死亡率降低相关的独立因素。
Left ventricular assist devices (LVADs) have dramatically improved short-term outcomes among patients with advanced heart failure. While neurohormonal blockade (NHB) is the cornerstone of treatment for patients with heart failure with reduced ejection fraction, its effect after LVAD placement has not been established. We reviewed medical records of 307 patients who underwent primary LVAD implantation from January 2006 to September 2015 at two institutions in the United States. Patients were followed for at least two years post LVAD implantation or until explantation, heart transplantation, or death. Cox regression analysis stratifying on center was used to assess associations with mortality. NHB use was treated as a time-dependent predictor. Stepwise selection indicated treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) (HR=0.53 (0.30–0.95), P = 0.03), age at the time of implantation (HR = 1.28 (1.05–1.56) per decade, P = 0.02), length of stay post implantation (HR = 1.16 (1.11–1.21) per week, P < 0.01) and INTERMACS profile of 1 or 2 (HR = 1.86 (1.17–2.97), P < 0.01) were independent predictors of mortality. In this large, retrospective study, treatment with ACEIs or ARBs was an independent factor associated with decreased mortality post LVAD placement.