North West Regional Heart Centre and Transplant Unit, University of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK.
Cardiovasc Ther. 2010 Spring;28(1):48-58. doi: 10.1111/j.1755-5922.2009.00125.x.
Following cardiac transplantation, registry data has demonstrated a gradual improvement in survival over the last several decades, which is testament to continual improvement in aftercare strategy. However, a significant number of patients will eventually develop a new syndrome of chronic heart failure, owing to the multitude of physiological processes that occur after transplantation. This condition, referred to as chronic graft failure (CGF) should be regarded as a unique illness rather than one that is simply analogous with chronic heart failure. In particular, the unique pathophysiological (and pharmacological) environment in the setting of CGF presents a challenging situation to the transplant physician. There is uncertainty over which treatments to offer given a paucity of clinical trial data to support the use of standard heart failure treatments in CGF. In this review, we discuss which chronic heart failure treatments could be considered in the setting of CGF based on their mechanisms of action, benefits within the native heart failure setting, and the relevant issues within the posttransplant environment.
心脏移植后，注册数据表明，在过去几十年中，患者的生存率逐渐提高，这证明了后续治疗策略的持续改进。然而，由于移植后发生的多种生理过程，相当数量的患者最终会出现新的慢性心力衰竭综合征。这种情况被称为慢性移植物衰竭（CGF），应该被视为一种独特的疾病，而不仅仅是与慢性心力衰竭相似的疾病。特别是，CGF 所处的独特的病理生理学（和药理学）环境给移植医生带来了挑战。由于缺乏临床试验数据支持将标准心力衰竭治疗方法应用于 CGF，因此对于提供哪些治疗存在不确定性。在这篇综述中，我们根据作用机制、在原生心力衰竭治疗中的益处以及移植后环境中的相关问题，讨论了在 CGF 背景下可以考虑的哪些慢性心力衰竭治疗方法。
