在因严重心力衰竭住院的患者中，使用主动脉血流增强（主动脉血流治疗）持续改善心功能：接受 Orqis 医疗 Cancion 系统增强治疗心力衰竭的多中心试验（MOMENTUM）对药物治疗无反应的心力衰竭的治疗效果。

Progressive improvement in cardiac performance with continuous aortic flow augmentation (aortic flow therapy) in patients hospitalized with severe heart failure: results of the Multicenter Trial of the Orqis Medical Cancion System for the Enhanced Treatment of Heart Failure Unresponsive to Medical Therapy (MOMENTUM).

机构信息

RHJ Department of Veterans Affairs Medical Center Charleston, Medical University of South Carolina, South Carolina 29425, USA.

出版信息

J Heart Lung Transplant. 2010 Jan;29(1):86-92. doi: 10.1016/j.healun.2009.10.005.

DOI:10.1016/j.healun.2009.10.005

PMID:20123246

Abstract

BACKGROUND

Previous studies indicate that superimposing incremental continuous flow on pulsatile aortic flow (aortic flow therapy, AFT) yields an increase in cardiac output. This study examined whether improvement in this hemodynamic index is independent of changes in loading conditions and represents an improvement in cardiac performance.

METHODS

The Multi-center Trial of Orqis Medical Cancion System for Enhanced Treatment of Heart Failure (HF) Unresponsive to Medical Therapy (MOMENTUM) was a randomized trial comparing AFT plus medical therapy (n = 109) vs medical therapy alone (n = 59) in patients hospitalized with HF inadequately responsive to therapy. Entry required reduced left ventricular ejection fraction (LVEF) and cardiac index, elevated pulmonary capillary wedge pressure (PCWP), and impaired renal function or high diuretic requirement despite intravenous inotrope or vasodilator treatment. AFT was achieved for up to 96 hours using an arterial-to-arterial circuit (flow up to 1.5 liters/min). Changes in cardiac performance were assessed using the relationship between cardiac index (CI) or stroke work (SW = stroke volume x [Mean blood pressure - PCWP] x 0.00133, kg.cm) and PCWP.

RESULTS

In the control group, a decrease in PCWP was accompanied by a decline in SW from 3.2 +/- 1.4 at baseline to 2.7 +/- 0.9 kg.cm at 4 days. AFT increased SW (from 3.0 +/- 1.6 at baseline to 3.3 +/- 1.7 kg.cm at 4 days; p < 0.0001) and decreased PCWP. An upward-leftward shift occurred in the SW vs PCWP relationship in the AFT group.

CONCLUSIONS

AFT resulted in a progressive upward-leftward shift in the SW-PCWP relation compared with the control group, demonstrating improvement in cardiac performance independent of load-related effects.

摘要

背景

先前的研究表明，在脉动主动脉血流上叠加递增的连续流（主动脉血流治疗，AFT）可增加心输出量。本研究旨在检验这种血流动力学指标的改善是否独立于负荷条件的变化，并代表心脏功能的改善。

方法

多中心 Orqis 医疗 Cancion 系统治疗心力衰竭（HF）的试验（MOMENTUM）是一项随机试验，比较了 AFT 加药物治疗（n = 109）与单独药物治疗（n = 59）在因治疗反应不佳而住院的 HF 患者中的疗效。入选标准为左心室射血分数（LVEF）和心指数降低，肺动脉楔压（PCWP）升高，以及尽管静脉内使用正性肌力药或血管扩张剂治疗仍存在肾功能损害或高利尿剂需求。使用动脉到动脉的回路（流量高达 1.5 升/分钟）实现 AFT 持续 96 小时。通过心指数（CI）或每搏功（SW = 每搏量 x [平均血压 - PCWP] x 0.00133，kg.cm）与 PCWP 之间的关系评估心脏功能的变化。

结果

在对照组中，PCWP 的下降伴随着 SW 从基线时的 3.2 ± 1.4 降至第 4 天时的 2.7 ± 0.9 kg.cm。AFT 增加了 SW（从基线时的 3.0 ± 1.6 增加到第 4 天时的 3.3 ± 1.7 kg.cm；p < 0.0001）并降低了 PCWP。AFT 组的 SW 与 PCWP 关系发生了向上向左的偏移。