心房分流术应用于射血分数降低的心力衰竭患者的探索性研究  

An Exploratory Study on the Effects of Interatrial Shunt for Patients With Heart Failure With Reduced Ejection Fraction

作　　者：常三帅 吴文辉[1] 刘新民[1] 姜正明 科雨彤 吕强[2] 杜昕[2] 董建增[2] 宋光远 CHANG Sanshuai;WU Wenhui;LIU Xinmin;JIANG Zhengming;KE Yutong;LYU Qiang;DU Xin;DONG Jianzeng;SONG Guangyuan(Interventional Center of Valvular Heart Disease,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Diseases,Beijing 100029,China;Heart Failure Center,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院,心脏瓣膜病介入中心,国家心血管病临床医学研究中心,北京100029 [2]首都医科大学附属北京安贞医院,心力衰竭中心,国家心血管病临床医学研究中心,北京100029

出　　处：《中国循环杂志》2024年第10期989-996,共8页Chinese Circulation Journal

摘　　要：目的:探索心房分流术对射血分数降低的心力衰竭(HFrEF)患者心功能和临床预后的影响。方法:本研究为前瞻性单组研究,连续入选2021年12月至2022年12月在首都医科大学附属北京安贞医院采用D-Shant心房分流器行心房分流术的15例HFrEF患者。术前及术后即刻行右心导管测量肺毛细血管楔压(PCWP)、右心房平均压(RAP)、跨房间隔梯度压差、肺动脉平均压、全肺阻力(TPR)、肺血管阻力(PVR)、心脏指数(CI)及肺循环血流量/体循环血流量(Qp/Qs);术后对患者进行12个月随访,采用超声心动图评估患者心脏结构和功能变化,采用NYHA心功能分级、6分钟步行距离(6MWD)、堪萨斯城心肌病问卷(KCCQ)评分评估患者心功能,收集患者全因死亡、心力衰竭再住院以及器械相关不良事件等信息。结果:所有患者均成功接受心房分流术。与术前相比,术后即刻患者的PCWP、跨房间隔梯度压差、TPR均显著下降,Qp/Qs显著升高(P均<0.01),肺动脉平均压、RAP、PVR和CI的差异均无统计学意义(P均>005)。术后即刻与术后12个月的心房分流器分流孔径、分流速度及分流压差差异均无统计学意义(P均>0.05)。与术前相比,术后12个月患者的左心室射血分数显著升高,NYHA心功能分级改善,KCCQ评分增高,6MWD>450 m的患者例数增加,N末端B型利钠肽原水平显著下降(P均<0.05),右心房内径、右心室面积变化率的差异均无统计学意义(P均>005)。12个月随访期内无患者死亡,无器械相关不良事件,2例患者因心力衰竭再住院。结论:小样本探索性研究表明心房分流术可有效改善HFrEF患者的血液动力学指标,随访12个月时患者心功能明显改善。Objectives:To explore the effects of interatrial shunt on cardiac function and clinical prognosis of patients with heart failure with reduced ejection fraction(HFrEF).Methods:This study was a prospective single-arm study.From December 2021 to December 2022,15 consecutive patients with HFrEF from Beijing Anzhen Hospital were enrolled in this study.Interatrial shunt was performed with a D-Shant atrial shunt device.Right heart catheterization was performed before and immediately after device implantation,pulmonary capillary wedge pressure(PCWP),mean right atrial pressure(RAP),interatrial gradient pressure,mean pulmonary artery pressure,total pulmonary resistance(TPR),pulmonary vascular resistance(PVR),cardiac index(CI),and pulmonary/systemic blood flow ratio(Qp/Qs)were measured.Patients were followed-up for 12 months after procedure,changes in cardiac structure and function were evaluated by echocardiography.NYHA classification,6-minute walking distance(6MWD),and Kansas City cardiomyopathy questionnaire(KCCQ)were observed.All-cause mortality and rehospitalization for heart failure served as clinical endpoints.Results:Interatrial shunt procedure was successful in all patients.Compared with preoperative value,PCWP,interatrial gradient pressure,mean pulmonary artery pressure,and TPR were significantly decreased,while Qp/Qs was significantly increased immediately after procedure(all P<0.01).There were no significant changes in RAP,PVR,and CI post procedure(all P>0.05).There were no significant differences in shunt size,shunt velocity,and shunt pressure difference between postoperative immediately and at 12-months follow-up(all P>0.05).At 12 months,left ventricular ejection fraction was significantly higher than baseline level(P<0.05),and there were no significant changes in right atrial diameter and right ventricular fractional area change(both P>0.05).Compared with preoperative status,NYHA classification was improved,KCCQ score was increased,and the number of patients with 6MWD>450 m was increased at 12 months(all P<0.

关 键 词：心力衰竭 心房分流术 右心导管 肺毛细血管楔压 左心室射血分数 

分 类 号：R54[医药卫生—心血管疾病]