From the Division of Cardiovascular Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio.
Division of Cardiology, University of Berne, Bern, Switzerland.
ASAIO J. 2018 May/Jun;64(3):301-308. doi: 10.1097/MAT.0000000000000670.
Proper timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients is not well established and is an area of intense interest. In addition, optimizing LVAD performance after implantation remains difficult and represents a significant clinical need. Implantable hemodynamic monitoring systems may provide physicians with the physiologic information necessary to improve the timing of LVAD implantation as well as LVAD performance when compared with current methods. The CardioMEMS Heart sensor Allows for Monitoirng of Pressures to Improve Outcomes in NYHA Class III heart failure patients (CHAMPION) Trial enrolled 550 previously hospitalized patients with New York Heart Association (NYHA) class III heart failure. All patients were implanted with a pulmonary artery (PA) pressure monitoring system and randomized to a treatment and control groups. In the treatment group, physicians used the hemodynamic information to make heart failure management decisions. This information was not available to physicians for the control group. During an average of 18 month randomized follow-up, 27 patients required LVAD implantation. At the time of PA pressure sensor implantation, patients ultimately requiring advanced therapy had higher PA pressures, lower systemic pressure, and similar cardiac output measurements. Treatment and control patients in the LVAD subgroup had similar clinical profiles at the time of enrollment. There was a trend toward a shorter length of time to LVAD implantation in the treatment group when hemodynamic information was available. After LVAD implantation, most treatment group patients continued to provide physicians with physiologic information from the hemodynamic monitoring system. As expected PA pressures declined significantly post LVAD implant in all patients, but the magnitude of decline was higher in patients with PA pressure monitoring. Implantable hemodynamic monitoring appeared to improve the timing of LVAD implantation as well as optimize LVAD performance when compared with current methods. Further studies are necessary to evaluate these findings in a prospective manner.
左心室辅助装置（LVAD）在晚期心力衰竭患者中的植入时机尚未确定，这是一个研究热点。此外，优化 LVAD 植入后的性能仍然很困难，这是一个重大的临床需求。植入式血流动力学监测系统可以为医生提供生理信息，以改善 LVAD 植入时机，并与当前方法相比，优化 LVAD 性能。CardioMEMS 心脏传感器允许监测压力以改善 NYHA Ⅲ级心力衰竭患者的预后（CHAMPION）试验纳入了 550 名先前因心力衰竭住院的 NYHA Ⅲ级心力衰竭患者。所有患者均植入肺动脉（PA）压力监测系统，并随机分为治疗组和对照组。在治疗组中，医生使用血流动力学信息做出心力衰竭管理决策。对照组的医生无法获得这些信息。在平均 18 个月的随机随访中，27 名患者需要植入 LVAD。在 PA 压力传感器植入时，最终需要高级治疗的患者 PA 压力更高、全身血压更低，而心输出量测量值相似。LVAD 亚组患者在入组时的临床特征相似。当有血流动力学信息时，治疗组的 LVAD 植入时间更短。在 LVAD 植入后，大多数治疗组患者继续向医生提供血流动力学监测系统的生理信息。正如预期的那样，所有患者的 PA 压力在 LVAD 植入后均显著下降，但在有 PA 压力监测的患者中，下降幅度更大。与当前方法相比，植入式血流动力学监测似乎改善了 LVAD 植入时机，并优化了 LVAD 性能。需要进一步的前瞻性研究来评估这些发现。
