Brener Michael I, Kapadia Samir R, Burkhoff Daniel
Division of Cardiology, Columbia University Medical Center, New York, New York.
Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio.
J Soc Cardiovasc Angiogr Interv. 2023 Dec 4;2(6Part B):101196. doi: 10.1016/j.jscai.2023.101196. eCollection 2023 Nov-Dec.
Chronic heart failure (HF) is a clinical syndrome of myocardial dysfunction characterized by inadequate cardiac output or preserved output that can only be achieved by sustaining abnormal loading conditions. Morphologically, HF with reduced left ventricular function results in progressive chamber remodeling, meaning the ventricle dilates, operating at larger end-diastolic and end-systolic volumes, and takes on an abnormal, spherical shape that increases wall stress. Reverse remodeling is the goal of HF-directed therapies and can be achieved by biological means, ie, altering the loading conditions that, at a cellular level, promote myocardial dysfunction, or physical means, ie, directly altering myocardial mass or shape. In this review, we highlight the existing and emerging device-based mechanisms for biologically and physically reverse remodeling the left ventricle in chronic HF.
慢性心力衰竭（HF）是一种心肌功能障碍的临床综合征，其特征是心输出量不足或仅通过维持异常负荷条件才能实现的心输出量保留。在形态学上，左心室功能降低的HF会导致进行性心室重塑，这意味着心室扩张，在更大的舒张末期和收缩末期容积下运作，并呈现出异常的球形，从而增加壁应力。逆向重塑是针对HF治疗的目标，可通过生物学手段实现，即改变在细胞水平上促进心肌功能障碍的负荷条件，或通过物理手段，即直接改变心肌质量或形状来实现。在本综述中，我们重点介绍了用于慢性HF中对左心室进行生物学和物理逆向重塑的现有及新兴的基于装置的机制。
