心室辅助装置在缺血性与非缺血性心肌病患者中的作用。

IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Eglė Rumbinaitė, Dainius Karčiauskas, Grytė Ramantauskaitė, Dovydas Verikas, Gabrielė Žūkaitė, Liucija Rancaitė, Barbora Jociutė, Gintarė Šakalytė, Remigijus Žaliūnas
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引用次数: 0

摘要

背景:HeartMate 3 (HM3)左心室辅助装置(LVAD)已经证明可以改善晚期心力衰竭(HF)患者的临床结果。然而,潜在的HF病因-缺血性心肌病(ICM)与扩张型心肌病(DCM)-对植入后结果的影响仍然没有充分的表征。目的:本文旨在评估ICM与DCM患者HM3 LVAD植入后的早期术后结果,并确定早期死亡和血流动力学不稳定的术前血流动力学和临床预测因素。方法:对2017年至2024年间30例HM3 LVAD植入患者进行回顾性单中心队列研究。根据HF病因对患者进行分层(ICM, n = 17;分析DCM (n = 13)、术前临床、超声心动图和右心导管资料。主要终点为术后30天生存率。次要终点包括术后血流动力学稳定性和对血管加压剂支持的需要。结果:非幸存者(n = 13)表现出中心静脉压升高(>16.5 mmHg),平均右心室压升高(>31.5 mmHg),肺血管阻力升高(>7.5 Wood单位),此外术前肌酐水平升高,体外循环时间延长。术后血管加压素需求与植入前肺动脉收缩压升高有关。结论:术前右侧压力和肾功能障碍是HM3左心室辅助器植入后早期死亡的重要预测因素。与DCM患者相比,ICM患者表现出更大的早期左心室恢复。这些发现强调了全面和个性化术前风险分层的重要性,特别是对于DCM和肺动脉高压患者,以优化术后结果并指导患者选择持久的LVAD支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Role of Ventricular Assist Devices in Patients with Ischemic vs. Non-Ischemic Cardiomyopathy.

Background: The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated improved clinical outcomes in patients with advanced heart failure (HF). However, the influence of underlying HF etiology-ischemic cardiomyopathy (ICM) versus dilated cardiomyopathy (DCM)-on post-implantation outcomes remains insufficiently characterized. Objectives: This paper aims to evaluate early postoperative outcomes following HM3 LVAD implantation in patients with ICM versus DCM and to identify the preoperative hemodynamic and clinical predictors of early mortality and hemodynamic instability. Methods: We conducted a retrospective single-center cohort study of 30 patients who underwent HM3 LVAD implantation between 2017 and 2024. Patients were stratified by HF etiology (ICM, n = 17; DCM, n = 13), and preoperative clinical, echocardiographic, and right heart catheterization data were analyzed. The primary endpoint was 30-day postoperative survival. Secondary endpoints included postoperative hemodynamic stability and the need for vasopressor support. Results: Non-survivors (n = 13) demonstrated elevated central venous pressure (>16.5 mmHg), mean right ventricular pressure (>31.5 mmHg), and pulmonary vascular resistance (>7.5 Wood units), in addition to higher preoperative creatinine levels and longer cardiopulmonary bypass times. Vasopressor requirement postoperatively was associated with elevated pre-implant systolic pulmonary artery pressure. Conclusions: Preoperative right-sided pressures and renal dysfunction are strong predictors of early mortality following HM3 LVAD implantation. Patients with ICM exhibit greater early left ventricular recovery compared to those with DCM. These findings underscore the importance of comprehensive and personalized preoperative risk stratification-particularly in patients with DCM and pulmonary hypertension-to optimize postoperative outcomes and guide patient selection for durable LVAD support.

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来源期刊
Journal of Personalized Medicine
Journal of Personalized Medicine Medicine-Medicine (miscellaneous)
CiteScore
4.10
自引率
0.00%
发文量
1878
审稿时长
11 weeks
期刊介绍: Journal of Personalized Medicine (JPM; ISSN 2075-4426) is an international, open access journal aimed at bringing all aspects of personalized medicine to one platform. JPM publishes cutting edge, innovative preclinical and translational scientific research and technologies related to personalized medicine (e.g., pharmacogenomics/proteomics, systems biology). JPM recognizes that personalized medicine—the assessment of genetic, environmental and host factors that cause variability of individuals—is a challenging, transdisciplinary topic that requires discussions from a range of experts. For a comprehensive perspective of personalized medicine, JPM aims to integrate expertise from the molecular and translational sciences, therapeutics and diagnostics, as well as discussions of regulatory, social, ethical and policy aspects. We provide a forum to bring together academic and clinical researchers, biotechnology, diagnostic and pharmaceutical companies, health professionals, regulatory and ethical experts, and government and regulatory authorities.
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