Gill Jashan
From the Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL.
Department of Medicine, Northwestern McHenry Hospital, McHenry, IL.
Cardiol Rev. 2023;31(3):128-138. doi: 10.1097/CRD.0000000000000432. Epub 2022 Jan 21.
Heart failure remains a substantial socioeconomic burden to our health care system. With the aging of the population, the incidence is expected to rise in the ensuing years. Standard heart failure management strategies have failed to reduce hospitalizations and mortality. In patients with heart failure, remote hemodynamic monitoring with implantable devices provides essential data, which can be used in unison with standard patient management to reduce heart failure hospitalizations. This review will chronicle the important clinical trials of various implantable devices and describe the emerging technologies in remote heart failure management. Cardiovascular implantable electronic devices, namely implanted cardioverter-defibrillator and cardiac resynchronization therapy devices with defibrillator, have evolved beyond sole resynchronization and currently can deliver real-time cardiac hemodynamics. Clinical data regarding hemodynamic monitoring with implanted cardioverter-defibrillator and cardiac resynchronization therapy devices with defibrillator have not consistently demonstrated a reduction in heart failure or mortality benefit. However, there is promise in the future with the application of multiparameter diagnostic algorithms with these devices. The most efficacious implantable device has been the pulmonary artery pressure sensor, CardioMEMS. This device has been proven to be safe and shown to reduce heart failure hospitalizations. Moreover, multiple newly developed devices are currently under investigation after successful first-in-man studies.
心力衰竭仍然是我们医疗保健系统的一项重大社会经济负担。随着人口老龄化，预计在接下来的几年中发病率将会上升。标准的心力衰竭管理策略未能降低住院率和死亡率。在心力衰竭患者中，使用可植入设备进行远程血流动力学监测可提供重要数据，这些数据可与标准的患者管理方法结合使用，以减少心力衰竭住院次数。本综述将按时间顺序记述各种可植入设备的重要临床试验，并描述心力衰竭远程管理中的新兴技术。心血管植入式电子设备，即植入式心脏复律除颤器和带有除颤器的心脏再同步治疗设备，已经超越了单纯的再同步功能，目前能够提供实时心脏血流动力学数据。关于使用植入式心脏复律除颤器和带有除颤器的心脏再同步治疗设备进行血流动力学监测的临床数据，并未始终如一地证明可降低心力衰竭或死亡率。然而，未来通过在这些设备上应用多参数诊断算法有望实现这一目标。最有效的可植入设备是肺动脉压力传感器CardioMEMS。该设备已被证明是安全的，并能减少心力衰竭住院次数。此外，在首次人体研究成功后，目前有多种新开发的设备正在进行研究。
