Department of Cardiology, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, Kingston-upon-Hull HU16 5JQ, UK.
Eur J Heart Fail. 2010 Jun;12(6):623-9. doi: 10.1093/eurjhf/hfq083.
This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure presented at the annual meeting of the American College of Cardiology held in March 2010. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. Results from DOSE suggest that giving diuretics using a high-dose, bolus strategy may be better than using lower doses or a continuous infusion for patients with acute decompensated heart failure. In the ASPIRE study, addition of aliskiren to standard therapy failed to attenuate left ventricular remodelling in post-MI patients and was associated with more adverse events. In CONNECT, remote monitoring reduced the time from CRT-D- or ICD-detected events to clinical decision and this was associated with fewer clinic visits and shorter hospitalizations. An analysis from STICH testing the effects of surgical ventricular reconstruction showed no benefit in the sub-group of patients who achieved a greater reduction in LV volume. STOP-AF and CABANA did not provide convincing evidence of the effectiveness or safety of catheter ablation for the treatment of AF. RACE II suggests that lenient heart rate control might be as effective as strict rate control in patients with permanent atrial fibrillation. In EVEREST II, a catheter-based mitral valve repair procedure using the MitraClip system had similar efficacy to traditional surgery but with fewer short-term adverse effects. Valsartan reduced progression to diabetes in patients with impaired glucose tolerance but had no effect on cardiovascular events in NAVIGATOR. In ACCORD, strict blood pressure control failed to reduce the risk of overall cardiovascular events in high-risk diabetic patients.
本文提供了 2010 年 3 月在美国心脏病学会年会上报告的与心力衰竭病理生理学、预防和治疗相关的试验信息和评论。未发表的报告应被视为初步结果，因为分析结果可能会在最终出版物中发生变化。DOSE 研究结果表明，对于急性失代偿性心力衰竭患者，使用大剂量推注利尿剂策略可能优于使用小剂量利尿剂或持续输注。在 ASPIRE 研究中，阿利吉仑联合标准治疗并不能减轻 MI 后患者的左心室重构，且与更多的不良事件相关。在 CONNECT 研究中，远程监测减少了 CRT-D 或 ICD 检测到事件到临床决策的时间，这与就诊次数减少和住院时间缩短相关。STICH 研究分析表明，对于 LV 容积减少更多的亚组患者，外科心室重构术没有带来益处。STOP-AF 和 CABANA 研究并未提供令人信服的证据表明导管消融治疗 AF 的有效性或安全性。RACE II 研究表明，对于永久性房颤患者，宽松的心率控制可能与严格的心率控制一样有效。在 EVEREST II 研究中，使用 MitraClip 系统的经导管二尖瓣修复术与传统手术具有相似的疗效，但短期不良事件较少。缬沙坦可减少糖耐量受损患者发生糖尿病的进展，但在 NAVIGATOR 研究中对心血管事件没有影响。在 ACCORD 研究中，严格的血压控制并不能降低高危糖尿病患者的总体心血管事件风险。
