Advances in Devices for Cardiac Resynchronization in Heart Failure

Patients with advanced heart failure have a high mortality and morbidity despite medical therapy. Depending on the underlying heart disease and severity of heart failure, 3.7 to 52.8% of patients have a QRS complex 120 ms who may have interventricular and intraventricular dyssynchrony correctible by cardiac resynchronization therapy (CRT). The latter is usually achieved with biventiricular pacing, with the left ventricular lead placed in a tributary of the coronary sinus (CS), with a reported success rate between 88–92%. The technical advances for implantation include preformed guide sheaths to canulate the CS, over the wire leads with passive fixation mechanism, and surgical placement methods.Device-specific CRT features include optimizing heart failure through ensurance of a high percentage of pacing, heart failure monitoring, atrioventricular and interventricular timing, and avoiding double ventricular sensing. Furthermore, arrhythmic co-morbidities of heart failure such as atrial fibrillation and ventricular tachyarrhythmias can also be managed. Recent prospective trials suggest that there is a 30% reduction in heart failure hospitalization with CRT, and preliminary results suggest a survival benefit with CRT and implantable cardioverter defibrillator over optimal medical therapy.     

左室辅助系统研究进展——心力衰竭终末阶段的机械支持

终末期心力衰竭对药物治疗反应差,患者多需等待心脏移植,但供体不足是突出矛盾而导致高病死率.左室辅助系统是采用机械动力泵将左室血液直接泵入主动脉,增强了左室收缩能力,降低左室的充盈压而增加全身的血液循环,不仅使终末期心力衰竭患者病死率下降并有时间过渡到移植阶段,更能使部分心力衰竭患者生活质量得到明显改善而成为终期治疗手段,应用前景广泛且光明.现就左室辅助系统的工作原理、临床管理、试验研究、并发症处理及应用前景等做一综述.     

Diabetes Mellitus in Advanced Heart Failure

BackgroundDiabetes mellitus is associated with increased rates of mortality in patients with less severe (stage C) heart failure (HF). The prevalence of diabetes and its complications in advanced (stage D) HF and their contributions to mortality risk are unknown.Methods and ResultsWe conducted a retrospective population-based cohort study of all adult residents of Olmsted County, Minnesota, who had advanced HF between 2007 and 2017. Patients with diabetes were identified by using the criteria of the Healthcare Effectiveness Data and Information Set. Diabetes complications were captured by using the Diabetes Complications Severity Index. Of 936 patients with advanced HF, 338 (36.1%) had diabetes. Overall, median survival time after development of advanced HF was 13.1 (3.9–33.1) months; mortality did not vary by diabetes status (aHR 1.06, 95% CI 0.90–1.25; P = 0.45) or by glycated hemoglobin levels in those with diabetes (aHR 1.01 per 1% increase, 95% CI 0.93–1.10; P = 0.82). However, patients with diabetes and 4 (aHR 1.24, 95% CI 0.92–1.67) or 5–7 (aHR 1.49, 95% CI 1.09–2.03) diabetes complications were at increased risk of mortality compared to those with ≤ 3 complications.ConclusionsMore than one-third of patients with advanced HF have diabetes. In advanced HF, overall prognosis is poor, but we found no evidence that diabetes is associated with a significantly higher mortality risk.     

Pulmonary Hypertension in Advanced Heart Failure

Abstract The diagnosis of pulmonary hypertension is easy during routine evaluation of patients with chronic heart failure by means of Doppler echocardiography. However, one must remember that an accurate hemodynamic characterization of the pulmonary circulation requires right heart catheterization to measure pulmonary vascular resistance and, if necessary, to test the reversibility of pulmonary hypertension. In addition, the importance of combining the right heart hemodynamic variables with a functional evaluation of the right ventricle is emphasized: in fact, the clinical impact of pulmonary hypertension in advanced heart failure patients (in terms of both exercise intolerance and prognosis) seems to be modulated by right ventricular function.     

心脏再同步治疗心力衰竭最新研究进展

心脏再同步治疗是一种非药物治疗心力衰竭的新方法。多项临床研究已证实,心脏再同步治疗可以显著改善患者的心功能,提高生活质量,减少患者的病死率及再住院率。