Stevenson Lynne Warner, Pagani Francis D, Young James B, Jessup Mariell, Miller Leslie, Kormos Robert L, Naftel David C, Ulisney Karen, Desvigne-Nickens Patrice, Kirklin James K
Brigham & Women's Hospital, Boston, Massachusetts, USA.
J Heart Lung Transplant. 2009 Jun;28(6):535-41. doi: 10.1016/j.healun.2009.02.015.
The current classification of patients with New York Heart Association Class IV symptoms does not offer adequate description to allow optimal selection of patients for the current options of medical and pacing therapies, cardiac transplantation and mechanical circulatory support.
Seven clinical profiles and an arrhythmia modifier were developed and implemented into the first year of data collection for the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). The INTERMACS Coordinators' Council provided ongoing feedback regarding the characterization of patients receiving implantable devices.
The definition of 7 clinical profiles revealed that 80% of current devices are being used in the 2 profiles with the highest levels of clinical compromise. The INTERMACS Coordinators' Council helped to identify gaps in the characterization of hospitalized patients on temporary assist devices and of homebound patients with resting symptoms, which has led to revised definitions of Profile 3 and 4 and the addition of 2 new modifiers, for temporary circulatory support devices in the hospital, and for frequent rehospitalization of patients at home.
Patients considered for mechanical circulatory support can now be classified using the 7 profiles plus 3 modifiers developed through INTERMACS. Further understanding these profiles and their impact on outcome should help to better select patients and therapies in the advanced stages of disease.
纽约心脏协会IV级症状患者的当前分类无法提供充分描述，以允许为当前的药物和起搏治疗、心脏移植及机械循环支持选择最佳患者。
制定了七种临床特征及一种心律失常修正因素，并在机构间机械辅助循环支持注册中心（INTERMACS）数据收集的第一年实施。INTERMACS协调员委员会就接受植入设备患者的特征描述提供持续反馈。
七种临床特征的定义显示，当前80%的设备用于临床损害程度最高的两种特征患者。INTERMACS协调员委员会帮助确定了临时辅助设备住院患者及有静息症状居家患者特征描述方面的差距，这导致对特征3和4的定义进行了修订，并增加了2个新的修正因素，分别针对医院中的临时循环支持设备以及居家患者的频繁再次住院情况。
现在可使用通过INTERMACS制定的7种特征加3个修正因素对考虑接受机械循环支持的患者进行分类。进一步了解这些特征及其对结局的影响应有助于在疾病晚期更好地选择患者和治疗方法。
