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Sustained Improvement in Diastolic Reserve Following Percutaneous Pericardiotomy in a Porcine Model of Heart Failure With Preserved Ejection Fraction.

射血分数保留的猪心力衰竭模型经皮心包切开术后舒张储备的持续改善。

  • 影响因子:4.83
  • DOI:10.1161/CIRCHEARTFAILURE.120.007530
  • 作者列表:"Jain CC","Pedrotty D","Araoz PA","Sugrue A","Vaidya VR","Padmanabhan D","Arunachalam SP","Lerman LO","Asirvatham SJ","Borlaug BA
  • 发表时间:2021-02-01
Abstract

BACKGROUND:Heart failure with preserved ejection fraction is increasing in prevalence, but few effective treatments are available. Elevated left ventricular (LV) diastolic filling pressures represent a key therapeutic target. Pericardial restraint contributes to elevated LV end-diastolic pressure, and acute studies have shown that pericardiotomy attenuates the rise in LV end-diastolic pressure with volume loading. However, whether these acute effects are sustained chronically remains unknown. METHODS:Minimally invasive pericardiotomy was performed percutaneously using a novel device in a porcine model of heart failure with preserved ejection fraction. Hemodynamics were assessed at baseline and following volume loading with pericardium intact, acutely following pericardiotomy, and then again chronically after 4 weeks. Cardiac structure was assessed by magnetic resonance imaging. RESULTS:The increase in LV end-diastolic pressure with volume loading was mitigated by 41% (95% CI, 27%-45%, P<0.0001; ΔLV end-diastolic pressure reduced from +9±3 mm Hg to +5±3 mm Hg, P=0.0003, 95% CI, -2.2 to -5.5). The effect was sustained at 4 weeks (+5±2 mm Hg, P=0.28 versus acute). There was no statistically significant effect of pericardiotomy on ventricular remodeling compared with age-matched controls. None of the animals developed hemodynamic or pathological indicators of pericardial constriction or frank systolic dysfunction. CONCLUSIONS:The acute hemodynamic benefits of pericardiotomy are sustained for at least 4 weeks in a swine model of heart failure with preserved ejection fraction, without excessive chamber remodeling, pericarditis, or clinically significant systolic dysfunction. These data support trials evaluating minimally invasive pericardiotomy as a novel treatment for heart failure with preserved ejection fraction in humans.

摘要

背景: 射血分数保留的心力衰竭的患病率正在增加,但有效的治疗方法很少。升高的左心室 (LV) 舒张充盈压代表了关键的治疗目标。心包约束导致左室舒张末压升高,急性研究表明,心包切开术可通过容量负荷减弱左室舒张末压的升高。然而,这些急性效应是否长期持续仍然未知。 方法: 在保留射血分数的猪心力衰竭模型中,使用一种新型装置经皮进行微创心包切开术。在基线和容量负荷后,用完整的心包,急性心包切开后,然后在4周后再次长期评估血流动力学。通过磁共振成像评估心脏结构。 结果: 左室舒张末压随容量负荷的增加减轻了41% (95% CI,27%-45%,P<0.0001; 左室舒张末压从 + 9 ± 3毫米mmhg降至 + 5 ± 3毫米mmhg,P = 0.0003,95% CI,-2.2至-5.5)。效果在4周时持续 (+ 5 ± 2毫米mmhg,与急性相比P = 0.28)。与年龄匹配的对照组相比,心包切开术对心室重构的影响没有统计学意义。没有动物出现心包收缩或明显收缩功能障碍的血液动力学或病理学指标。 结论: 在射血分数保留、无过度心室重构、心包炎或临床上显著的收缩功能障碍的心力衰竭猪模型中,心包切开术的急性血流动力学益处持续至少4周。这些数据支持评估微创心包切开术作为一种新型治疗射血分数保留的人类心力衰竭的试验。

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