Cleland John G F, Coletta Alison P, Abdellah Ahmed Tageldien, Cullington Damien, Clark Andrew L, Rigby Alan S
Department of Cardiology, University of Hull, Castle Hill Hospital, Cottingham, Kingston-upon-Hull, HU16 5JQ, UK.
Eur J Heart Fail. 2008 Jan;10(1):102-8. doi: 10.1016/j.ejheart.2007.12.004.
This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure, presented at the American Heart Association 2007. These should be considered as preliminary data, as analyses may change in the final publication. Rosuvastatin did not reduce mortality compared to placebo in patients with heart failure and left ventricular systolic dysfunction due to ischaemic heart disease in the CORONA study. Results of RethinQ provide equivocal evidence of benefit from CRT in patients with heart failure, echocardiographic dyssynchrony and QRS interval <130 ms. In the MASCOT study, the addition of atrial overdrive pacing did not reduce the incidence of permanent atrial fibrillation in patients receiving CRT. The AF-CHF study failed to show a benefit of rhythm control over rate control in patients with heart failure and atrial fibrillation. Self-management skills training and education had no benefit on the combined outcome of death or heart failure hospitalisation, compared with education alone in heart failure patients in the HART study. Microvolt T-wave alternans testing failed to identify patients at increased risk of life-threatening ventricular arrhythmias in the MASTER study. POISE suggests that initiating metoprolol therapy shortly prior to non-cardiac surgery increases the risk of hypotension, stroke and death, despite reducing the risk of myocardial infarction. Three trials of stem cell therapy in post-MI patients gave conflicting results.
本文提供了在2007年美国心脏协会会议上发表的与心力衰竭的病理生理学、预防和治疗相关试验的信息及评论。由于最终发表时分析可能会有所变化，这些应被视为初步数据。在CORONA研究中，对于因缺血性心脏病导致心力衰竭和左心室收缩功能障碍的患者，与安慰剂相比，瑞舒伐他汀并未降低死亡率。RethinQ的结果表明，对于心力衰竭、超声心动图显示不同步且QRS间期<130毫秒的患者，心脏再同步治疗（CRT）的获益证据不明确。在MASCOT研究中，对于接受CRT的患者，增加心房超速起搏并未降低永久性心房颤动的发生率。AF-CHF研究未能表明在心力衰竭合并心房颤动的患者中，节律控制优于心率控制。在HART研究中，与仅接受教育相比，自我管理技能培训和教育对心力衰竭患者死亡或心力衰竭住院的综合结局并无益处。在MASTER研究中，微伏T波交替试验未能识别出有危及生命的室性心律失常风险增加的患者。POISE研究表明，在非心脏手术前不久开始美托洛尔治疗，尽管降低了心肌梗死风险，但会增加低血压、中风和死亡的风险。三项针对心肌梗死后患者的干细胞治疗试验结果相互矛盾。
