Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Division of Cardiac Surgery, University of Michigan School of Medicine, Ann Arbor, Mich.
J Thorac Cardiovasc Surg. 2017 Jul;154(1):165-170. doi: 10.1016/j.jtcvs.2017.03.033. Epub 2017 Mar 19.
The medical burden of heart failure (HF) has spurred interest in clinicians and scientists to develop therapies to restore the function of a failing heart. To advance this agenda, the National Heart, Lung, and Blood Institute (NHLBI) convened a Working Group of experts from June 2 to 3, 2016, in Bethesda, Maryland, to develop NHLBI recommendations aimed at advancing the science of cardiac recovery in the setting of mechanical circulatory support (MCS). MCS devices effectively reduce volume and pressure overload that drives the cycle of progressive myocardial dysfunction, thereby triggering structural and functional reverse remodeling. Research in this field could be innovative in many ways, and the Working Group specifically discussed opportunities associated with genome-phenome systems biology approaches; genetic epidemiology; bioinformatics and precision medicine at the population level; advanced imaging modalities, including molecular and metabolic imaging; and the development of minimally invasive surgical and percutaneous bioengineering approaches. These new avenues of investigations could lead to new treatments that target phylogenetically conserved pathways involved in cardiac reparative mechanisms. A central point that emerged from the NHLBI Working Group meeting was that the lessons learned from the MCS investigational setting can be extrapolated to the broader HF population. With the precedents set by the significant effect of studies of other well-controlled and tractable subsets on larger populations, such as the genetic work in both cancer and cardiovascular disease, the work to improve our understanding of cardiac recovery and resilience in MCS patients could be transformational for the greater HF population.
心力衰竭（HF）的医疗负担促使临床医生和科学家们开发出恢复衰竭心脏功能的疗法。为了推进这一议程，美国国立心肺血液研究所（NHLBI）于 2016 年 6 月 2 日至 3 日在马里兰州贝塞斯达召集了一个专家组，制定旨在推进机械循环支持（MCS）环境中心脏恢复科学的 NHLBI 建议。MCS 设备可有效减少导致进行性心肌功能障碍的循环中容量和压力过载，从而触发结构和功能的反向重塑。该领域的研究在许多方面都具有创新性，工作组特别讨论了与基因组-表型系统生物学方法；遗传流行病学；人群水平的生物信息学和精准医学；先进的成像方式，包括分子和代谢成像；以及微创外科和经皮生物工程方法相关的机会。这些新的研究途径可能会带来新的治疗方法，针对与心脏修复机制相关的进化保守途径。NHLBI 工作组会议提出的一个要点是，从 MCS 研究环境中获得的经验教训可以外推到更广泛的 HF 人群。鉴于其他经过良好控制和易于处理的亚组的研究对更大人群产生的重大影响，例如癌症和心血管疾病中的遗传研究，为更好地了解 MCS 患者的心脏恢复和弹性而开展的工作可能会为更大的 HF 人群带来变革。
