Drakos Stavros G, Mehra Mandeep R
Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Brigham and Women's Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts.
J Heart Lung Transplant. 2016 Apr;35(4):413-20. doi: 10.1016/j.healun.2016.01.001. Epub 2016 Jan 13.
Myocardial remodeling induced by pressure and volume overload drives the vicious cycle of progressive myocardial dysfunction in chronic heart failure (HF). Mechanical volume and pressure unloading induced by implantable cardiac assist devices allows a reversal of stress-related compensatory responses of the overloaded myocardium so that selected patients requiring long-term mechanical circulatory support for advanced HF can achieve clinically meaningful degrees of improvement in the structure and function of their native heart. Insights from clinical and translational studies on myocardial recovery with mechanical circulatory support may enhance the understanding of how the pathophysiologic mechanisms of HF progression might be reversed. The end points of ongoing and future translational and clinical studies are discussed to identify specific investigational strategies that may advance the field of myocardial recovery driven by hemodynamic unloading of the heart.
压力和容量超负荷诱导的心肌重塑驱动了慢性心力衰竭（HF）中进行性心肌功能障碍的恶性循环。植入式心脏辅助装置引起的机械性容量和压力卸载可使超负荷心肌的应激相关代偿反应发生逆转，从而使部分因晚期HF需要长期机械循环支持的患者，其自身心脏的结构和功能能在临床上实现有意义的改善。关于机械循环支持下心肌恢复的临床及转化研究所得出的见解，可能会增进我们对HF进展的病理生理机制如何得以逆转的理解。本文讨论了正在进行的以及未来的转化和临床研究的终点，以确定可能推动由心脏血液动力学卸载驱动的心肌恢复领域发展的具体研究策略。
