心室辅助装置+“积极性”药物治疗可能会抑制严重心衰

一项正在进行的研究的初步结果表明：心脏植入装置和强化药物治疗组合可能会帮助终末期心衰病人，增强其心脏功能。其中研究了36位病人，给他们移植了一种左心室辅助装置（LVAD），一种心脏泵。

心脏病专家，Dr. Michael Kim，审查了新的发现，解释道：“接受了这种辅助设备的病人一般也在排队接受心脏移植。”

Kim，他在纽约勒诺克斯山医院指导心脏介入手术。他说“因为相对于心脏移植的需求，没有足够合适的心脏可以移植，这些新的辅助设备使这些病人存活直到有合适供移植的心脏出现，有时需要等很多年，”

这个新的研究由路易斯威尔大学医学教授 Emma Birks指导。研究中的病人除了接受了左心室辅助装置外，还增加了一个积极的药物方案，包括：赖诺普利；安体舒通；地高辛；氯沙坦；和卡维地洛。

用这个组合治疗后，其中13位病人在平均344天后左心室辅助装置泵移除，调查者说。两名左心室辅助装置泵的病人仍需要心脏移植，根据报告，这里有一位应用左心室辅助装置泵的病人死亡。

其他20位病人一直需要辅助装置泵，但是有2位病人移除了他们的辅助装置，研究者说。调查研究结果将会在周日新奥尔良美国心脏协会的年度会议上做演讲。

结果显示“即使很严重的心脏衰竭也可以用这些心脏泵来改变，尤其增加了额外的药物治疗后，这样可以避免这些病人心脏移植的需要，心脏捐献者可为另一个人提供需要，”Birks在心脏协会新闻发布会上说。

“几个中心显示已经应用了设备和药物组合来转变心脏衰竭，而且可能规模不小”，她补充道。“以往认为这些设备很少足以让他们恢复心功能而移除这些设备，但是这个研究显示这个可能比原来的想象要大很多，特别是组合了药物治疗后。”

这些发现鼓舞了Kim，但是这个研究有点小“需要更多的随访来确认这个观察”。专家还指出，在医学会议上提出的研究通常被认为是初步的，直到发表在同行评审的期刊上。

David 先生是N.Y.瓦利斯特里姆北岸-LIJ富兰克林医院，充血性心力衰竭主任。他称这个研究是“非常积极的初步研究”，研究显示“通过使用策略来帮助晚期心脏衰竭病人，一定会帮助病人全面提高临床疗效，获得更好的生活质量。

更多的信息：

美国国家心脏、肺和血液研究所对心力衰竭有更多的研究。

资源：Michael Kim,纽约，勒诺克斯山医院，心脏导管室，介入心脏病学，主任，医学博士；  David Friedman,N.Y.瓦利斯特里姆，北岸-LIJ富兰克林医院，充血性心力衰竭治疗主任，医学博士; 2016年11月13日，美国心脏协会，新闻发布。（美域健康赵霞编译）

           Device Plus 'Aggressive' Drug Strategy May Curb Severe Heart Failure

Small study suggests real improvement for some patients, but more follow-up research is needed.

Device Plus 'Aggressive' Drug Strategy May Curb Severe Heart Failure

SUNDAY, Nov. 13, 2016 (HealthDay News) -- A combination of an implanted heart device and intensive drug therapy may help boost heart function in end-stage heart failure patients, preliminary results of an ongoing study suggest.

The research focused on 36 patients who were implanted with what's known as a left ventricular assist device (LVAD), a kind of heart pump.

"Patients who receive this assist device generally are in line to receive a heart transplant," explained cardiologist Dr. Michael Kim, who reviewed the new findings.

"Because there are not nearly enough hearts available for transplantation relative to the need for heart transplantation, these newer assist devices can keep these sick patients alive until a heart does become available, sometimes for years," said Kim. He directs interventional cardiology at Lenox Hill Hospital in New York City.

The new study was led by Dr. Emma Birks, professor of medicine at the University of Louisville. Besides receiving the LVAD, patients in the study were also prescribed an aggressive regimen of five different drugs: lisinopril (Prinivil); spironolactone (Aldactone); digoxin (Lanoxin); losartan (Cozaar); and carvedilol (Coreg).

With this combined therapy, 13 (nearly one-third) of the patients recovered enough heart function after an average of 344 days to have the LVAD pump removed, the researchers said. Two patients who still had pumps received needed heart transplants, and one who still had a pump died, according to the report.

The 20 other patients still have their pumps, but two are scheduled to have their devices removed, the study authors said. The findings were scheduled for presentation Sunday at the American Heart Association's annual meeting, in New Orleans.

The results suggest "that even very advanced heart failure can be reversed using these heart pumps, particularly when combined with additional drug therapy, avoiding the need for heart transplantation for these patients and making the donor heart available for another needy individual," Birks said in a heart association news release.

"The fact that this could be done in several centers suggests that using the device with this drug combination to reverse heart failure is possible on a larger scale," she added. "It has previously been thought that these devices rarely recover heart function enough to allow them to be removed, but this study suggests that this can occur in a much bigger number than originally thought, particularly if combined with drug therapy."

Kim was encouraged by the findings, but stressed that the study was small and "more follow-up is needed to confirm this observation." Experts also note that studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Dr. David Friedman is chief of congestive heart failure services at North Shore-LIJ's Franklin Hospital in Valley Stream, N.Y. He called the study "very positive preliminary research," which shows that "strategies used to help advanced heart failure patients definitely help to try to have patients get improved overall clinical outcomes and better quality of life going forward."

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart failure.

SOURCES: Michael Kim, M.D., director, cardiac cath labs and interventional cardiology, Lenox Hill Hospital, New York City; David Friedman, M.D., chief, congestive heart failure services, North Shore-LIJ's Franklin Hospital, Valley Stream, N.Y.; American Heart Association, news release, Nov. 13, 2016