Institute of Cardiology, Warszawa, Poland.
Cardiol J. 2009;16(6):493-9.
A significant progress in the treatment of heart failure occurred during the last 20 years. These advances were associated with the introduction and subsequent widespread use of angiotensin- -converting enzyme inhibitors and beta blockers, but also with progress in device therapy and cardiac surgery. Overall, prognosis in patients with severe heart failure is similar to outcomes reported in multicenter randomized clinical trials, such as CONSENSUS, CIBIS II, MERIT-HF, and COPERNICUS. In 2003-2007, a registry of patients with severe heart failure was established in Poland (POLKARD-HF) that included all patients initially considered candidates for heart transplantation (HTX). Mean duration of follow-up was 601 days (range 1-1462 days). One-year mortality (defined as death or super-urgent HTX) was 20% and differed from data presented by Stewart (2001). In addition, patient survival in the POLKARD-HF registry depending on the New York Heart Association (NYHA) class changed significantly in comparison to outcomes reported in the late 1980s. However, one-year mortality among NYHA class IV patients is still high and exceeds 50%. As reported in the POLKARD-HF registry, one- -year risk of death among patient who underwent elective HTX was about 20%, and 3-year risk was about 22%, significantly different from the risk of death among medically treated patients with heart failure. These results are similar to other European data and warrant reconsideration of appropriatness of HTX in elective patients (UNOS 2 status). Undoubtedly, NYHA class IV patients are candidates for HTX and should remain under specialist care in cardiac transplantation centers, and HTX should be performed in this group when indications for this procedure become urgent (UNOS 1 and 1a status). A specialized system of care for patients with severe heart failure should be created in Poland, particularly for patients referred for HTX. There is also an urgent need to introduce modern systems of mechanical cardiac support (left ventricular assist devices, LVAD) that would allow precise determination of indications and contraindications to HTX and create opportunities for long-term treatment.
在过去的 20 年中，心力衰竭的治疗取得了重大进展。这些进展与血管紧张素转换酶抑制剂和β受体阻滞剂的引入及其广泛应用有关，但也与器械治疗和心脏手术的进展有关。总的来说，严重心力衰竭患者的预后与 CONSENSUS、CIBIS II、MERIT-HF 和 COPERNICUS 等多中心随机临床试验报告的结果相似。2003-2007 年，波兰建立了一个严重心力衰竭患者登记处（POLKARD-HF），该登记处纳入了所有最初被认为是心脏移植（HTX）候选者的患者。中位随访时间为 601 天（范围 1-1462 天）。一年死亡率（定义为死亡或超紧急 HTX）为 20%，与 Stewart（2001 年）报告的数据不同。此外，与 20 世纪 80 年代末报告的结果相比，POLKARD-HF 登记处患者的生存情况根据纽约心脏协会（NYHA）分级有显著变化。然而，NYHA 分级 IV 患者的一年死亡率仍然很高，超过 50%。正如 POLKARD-HF 登记处报告的那样，接受选择性 HTX 的患者一年死亡风险约为 20%，3 年风险约为 22%，与心力衰竭接受药物治疗的患者的死亡风险显著不同。这些结果与其他欧洲数据相似，需要重新考虑选择性 HTX 患者的适宜性（UNOS 2 状态）。毫无疑问，NYHA 分级 IV 患者是 HTX 的候选者，应继续在心脏移植中心接受专家护理，当该手术的适应证变得紧急时（UNOS 1 和 1a 状态），应在该组中进行 HTX。波兰应建立一个严重心力衰竭患者的专门护理系统，特别是为接受 HTX 转诊的患者。还迫切需要引入现代机械心脏支持系统（左心室辅助装置，LVAD），以便能够准确确定 HTX 的适应证和禁忌证，并为长期治疗创造机会。
