Circulation:有心衰或左室功能不全的稳定型缺血性心脏病患者应直接采用侵入性治疗

2020-11-03 星云 MedSci原创

对有心衰(HF)或左心室功能不全(LVD)病史、且射血分数&ge;35%但<45%的、至少中度缺血的稳定型缺血性心脏病患者,予以初始侵袭性治疗是否能改善预后尚不清楚。

对有心衰(HF)或左心室功能不全(LVD)病史、且射血分数≥35%但<45%的、至少中度缺血的稳定型缺血性心脏病患者,予以初始侵袭性治疗是否能改善预后尚不清楚。

随机分至ISCHEMIA(对比药物治疗和介入治疗的健康效益的国际性研究)的5179位受试者的左室射血分数(LVEF)均≥35%。Lopes等在这些受试者中对比起始时有无HF/LVD病史对血管预后的影响。中位随访3.2年。

有无HF/LVD病史患者的预后

起始时有HF/LVD病史的受试者有398位(7.7%),其中177位的HF/LVEF>45%,28位的HF/LVEF在35%和45%之间;193位的LVEF在35%和45%之间,但无HF病史。HF/LVD与更多的共发病相关,特别是既往心肌梗死卒中和高血压。

主要结局累积发生情况

与无HF/LVD的患者相比,HF/LVD患者更可能发生心血管死亡、非致死性心肌梗死或因不稳定心绞痛、心衰或心脏骤停复苏而住院的主要结局(4年累积发生率:22.7% vs 13.8%;心血管死亡或心肌梗死:19.7% vs 12.3%;全因死亡或HF:15.0% vs 6.9%)。被随机分至侵入性治疗的HF/LVD患者较分至常规药物治疗的患者的主要结局率更低(17.2% vs 29.3%),但无HF/LVD病史的患者无此差别(13.0% vs 14.6%)。

根据LVEF分析主要结局、全因死亡率和心血管死亡率

以LVEF作为有和无HF病史患者的连续变量来分析有创治疗和保守治疗相关预后时,在主要结局、全因死亡率和心血管死亡率方面也发现了类似的差异效应。

总之,ISCHEMIA试验中有HF或LVD病史的至少中度缺血的稳定型缺血性心脏病患者的主要结局发生风险增加。在有HF病史、LVEF在35%~45%的高风险患者群中,初始直接进行有创治疗可提高无事件存活率。

原始出处:

Renato D. Lopes, et al. Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction. Circulation. 2020;142:1725–1735

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    2020-11-04 Nebula-Qin

    心衰

    0

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对于保留射血分数的心力衰竭患者,可溶性鸟苷酸环化酶刺激剂Praliciguat不能改善患者峰值摄氧量

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SGLT2(钠-葡萄糖同向转运体2)抑制剂可改善2型糖尿病患者心力衰竭相关的预后。在心力衰竭患者中,SGLT2抑制剂可能与袢利尿剂具有协同作用,但这种联合作用尚不明确。该研究(RECEDE-CHF)目