Visco Valeria, Esposito Cristina, Manzo Michele, Fiorentino Antonio, Galasso Gennaro, Vecchione Carmine, Ciccarelli Michele
Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy.
Cardiology Unit, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy.
Front Cardiovasc Med. 2022 Apr 4;9:874433. doi: 10.3389/fcvm.2022.874433. eCollection 2022.
During the last years, the management of heart failure (HF) made substantial progress, focusing on device-based therapies to meet the demands of this complex syndrome. In this case report, we present a multistep approach to deal with HF. Specifically, we report the first patient subjected to the implantation of both Optimizer Smart (Impulse Dynamics Inc., Marlton, NJ, USA) and CardioMEMS devices. A 72-year-old male patient with HF and reduced ejection fraction (HFrEF) was admitted to our cardiology department in January 2021, following a progressive shortening of the time between hospitalizations for levosimendan infusions. Specifically, the patient was monitored daily by CardioMEMS, and a strategy of levosimendan infusions guided by the device had been adopted. He was also a carrier of MitraClips and cardiac resynchronization therapy defibrillator (CRT-D) and had optimized HF medical therapy. In January 2021, the patient implanted Optimizer Smart device for cardiac contractility modulation (CCM) therapy because of poor response to therapy and elevated pulmonary artery pressure (PAP). CCM significantly reduced PAP values following discharge (systolic PAP 33.67 ± 2.92 vs. 40.6 ± 3.37 mmHg, diastolic PAP 14.5 ± 2.01 vs. 22.5 ± 2.53 mmHg, mean PAP 22.87 ± 2.20 vs. 30.9 ± 2.99 mmHg, HR 60.93 ± 1.53 vs. 80.83 ± 3.66 bpm; < 0.0001), with persisting effect at 9 months. The usefulness of CCM is objectively demonstrated for the first time by continuous invasive monitoring of PAP by CardioMEMS, which can suggest the correct timing for CCM implantation.
在过去几年中，心力衰竭（HF）的管理取得了重大进展，重点是基于设备的治疗方法，以满足这种复杂综合征的需求。在本病例报告中，我们展示了一种处理HF的多步骤方法。具体而言，我们报告了首例同时植入Optimizer Smart（美国新泽西州马尔顿市脉冲动力公司）和CardioMEMS设备的患者。一名72岁男性HF患者，射血分数降低（HFrEF），因左西孟旦输注住院间隔时间逐渐缩短，于2021年1月入住我院心内科。具体来说，该患者每天由CardioMEMS进行监测，并采用了由该设备指导的左西孟旦输注策略。他还植入了MitraClips和心脏再同步化治疗除颤器（CRT-D），并接受了优化的HF药物治疗。2021年1月，由于对治疗反应不佳且肺动脉压（PAP）升高，该患者植入了Optimizer Smart设备进行心脏收缩力调制（CCM）治疗。出院后CCM显著降低了PAP值（收缩期PAP：33.67±2.92 vs. 40.6±3.37 mmHg，舒张期PAP：14.5±2.01 vs. 22.5±2.53 mmHg，平均PAP：22.87±2.20 vs. 30.9±2.99 mmHg，心率：60.93±1.53 vs. 80.83±3.66次/分钟；P<0.0001），且在9个月时仍有持续效果。CardioMEMS对PAP的连续有创监测首次客观证明了CCM的有效性，这可以提示CCM植入的正确时机。
