体外反搏与心功能保护——PEECH研究结果解读

体外反搏治疗用于左室功能正常的冠心病心绞痛患者,可以改善患者的心绞痛症状和运动耐量。为探讨体外反搏治疗对收缩性心功能不全患者的疗效,PEECH研究评价了体外反搏在轻-中度心力衰竭患者治疗中的益处。187个轻-中度有症状的心力衰竭患者被随机分配给予体外反搏治疗联合已发表指南所要求的常规药物治疗或单纯常规药物治疗。两个主要观察终点是：6个月随访时,运动时间至少延长60s的病人百分数以及峰值氧耗量至少提高1.25ml/（min.kg）的病人百分数。PEECH研究结果显示,体外反搏治疗可以提高患者的运动耐量、功能状态和生活质量,但是不影响峰值氧耗量。PEECH研究存在一些局限性,比如未能对病人进行设盲,体外反搏治疗的有效性可能归因于安慰剂效应。因此,需要设计更好的临床试验来帮助评价体外反搏用于慢性心力衰竭治疗的整体效应及其作用机制。

Enhanced External Counterpulsation and Protection of Heart Function:Results from PEECH Trial

Enhanced external counterpulsation （ EECP） improved angina symptoms and exercise tolerance in patients with coronary ar- tery disease with normal left ventricular function. To address the efficacy of EECP in patients with heart failure （HF） secondary to systolic dysfunction, PEECH （ Prospective Evaluation of Enhanced External Counterpulsation in Congestive Heart Failure } study assessed the benefits of enhanced external counterpulsation in the treatment of patients with mild-to-moderate heart failure （ HF）. 187 patients with mild-to-moder- ate symptoms of HF were randomized to either EECP combined with routine pharmacologic therapy { PT} per published guidelines or PT a- lone. Two co-primary end points were the percentage of subjects with a 60 seconds or more increase in exercise duration and the percentage of subjects with at least 1.25 ml/（ min ~ kg） increase in peak volume of oxygen uptake （ VO2 ） at 6 months. The PEECH trial demonstrated that EECP therapy increased exercise duration and improved functional status and quality of life without affecting peak oxygen consumption. There were some limitations for PEECH trial. For example, the patients were not blinded to therapy, so the benefits of EECP may be attributable to a ＂placebo＂ effect. Better-controlled studies are needed to help elucidate both the overall effects of EECP and the mechanism of action.