心力衰竭症状生物学对心室辅助装置植入的反应。
Heart Failure Symptom Biology in Response to Ventricular Assist Device Implantation.
机构信息
Christopher S. Lee, PhD, RN, FAHA, FAAN, FHFSA Professor and Associate Dean for Research, Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts. James O. Mudd, MD Associate Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Karen S. Lyons, PhD, FGSA Associate Professor, Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts. Quin E. Denfeld, PhD, RN Assistant Professor, Oregon Health & Science University School of Nursing, Portland. Corrine Y. Jurgens, PhD, RN, FAHA, FAAN, FHFSA Associate Professor, Stony Brook University School of Nursing, New York. Bradley E. Aouizerat, MS, PhD Professor, New York University School of Dentistry, Department of Oral and Maxillofacial Surgery. Jill M. Gelow, MD, MPH Cardiologist, Providence Health, Portland, Oregon. Christopher V. Chien, MD Assistant Professor, University of North Carolina REX Healthcare, Raleigh. Emily Aarons Undergraduate Research Fellow, Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts. Kathleen L. Grady, PhD, RN, FAHA, FAAN, FHFSA Professor, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
出版信息
J Cardiovasc Nurs. 2019 Mar-Apr;34(2):174-182. doi: 10.1097/JCN.0000000000000552.
BACKGROUND
We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF), particularly in response to left ventricular assist device (LVAD) implantation.
OBJECTIVE
The aim of this study was to quantify the degree to which symptoms and biomarkers change in parallel from before implantation through the first 6 months after LVAD implantation in advanced HF.
METHODS
This was a prospective cohort study of 101 patients receiving an LVAD for the management of advanced HF. Data on symptoms (dyspnea, early and subtle symptoms [HF Somatic Perception Scale], pain severity [Brief Pain Inventory], wake disturbance [Epworth Sleepiness Scale], depression [Patient Health Questionnaire], and anxiety [Brief Symptom Inventory]) and peripheral biomarkers of myocardial stretch, systemic inflammation, and hypervolumetric mechanical stress were measured before implantation with a commercially available LVAD and again at 30, 90, and 180 days after LVAD implantation. Latent growth curve and parallel process modeling were used to describe changes in symptoms and biomarkers and the degree to which they change in parallel in response to LVAD implantation.
RESULTS
In response to LVAD implantation, changes in myocardial stretch were closely associated with changes in early and subtle physical symptoms as well as depression, and changes in hypervolumetric stress were closely associated with changes in pain severity and wake disturbances. Changes in systemic inflammation were not closely associated with changes in physical or affective symptoms in response to LVAD implantation.
CONCLUSIONS
These findings provide new insights into the many ways in which symptoms and biomarkers provide concordant or discordant information about LVAD response.
背景
我们对心力衰竭（HF）症状的生物学基础，尤其是对左心室辅助装置（LVAD）植入后的反应了解有限。
目的
本研究旨在定量评估在接受 LVAD 治疗的晚期 HF 患者中，症状和生物标志物从植入前到植入后 6 个月的变化程度。
方法
这是一项前瞻性队列研究，共纳入 101 例接受 LVAD 治疗的晚期 HF 患者。在植入前和植入后 30、90 和 180 天，使用商业上可用的 LVAD 测量症状（呼吸困难、早期和细微症状[HF 躯体知觉量表]、疼痛严重程度[简明疼痛量表]、觉醒障碍[Epworth 嗜睡量表]、抑郁[患者健康问卷]和焦虑[简明症状量表]）和外周生物标志物（心肌拉伸、全身炎症和超容性机械应激）。采用潜在增长曲线和并行过程建模来描述症状和生物标志物的变化，并评估它们在 LVAD 植入后的变化程度。
结果
在 LVAD 植入后，心肌拉伸的变化与早期和细微的躯体症状以及抑郁的变化密切相关，而超容性应激的变化与疼痛严重程度和觉醒障碍的变化密切相关。全身炎症的变化与 LVAD 植入后躯体或情感症状的变化没有密切关联。
结论
这些发现为症状和生物标志物在 LVAD 反应中提供一致或不一致信息的多种方式提供了新的见解。
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