心衰治疗设备概览

Heart Failure Device Therapies: An Overview      

      在周二早上的心衰治疗设备分会上，来自纽约哥伦比亚大学的Daniel Burkhoff教授对目前治疗心衰的设备进行了回顾和分析。

（来源：www.tctmd.com）

Heart Failure Device Therapies: An Overview      
 
Key Points:

Current electrical and mechanical treatments for CHF improved cardiac function, survival.

By TCT Daily Staff

In a Tuesday morning session on device-based approaches for heart failure, Daniel Burkhoff, MD, PhD, of Columbia University Medical Center in New York, presented an overview of current device therapies for congestive heart failure.

Burkhoff said that even though modern drug therapies have made a significant impact on outcomes in patients with CHF, morbidity and mortality remain high. Roughly 35% of CHF patients are NYHA class III or IV, and five-year mortality rates for these classes are 35% to 50% and >50%, respectively.

CRT

Cardiac resynchronization therapy (CRT) – a treatment for conduction disturbances and ventricular dyssynchrony – is indicated for patients with prolonged QRS duration. According to research cited by Burkhoff, CRT improves quality of life and functional class, as well as cardiac function and structure.

In addition, important evidence has emerged about the impact of CRT on mortality, with the CARE-HF trial showing an absolute reduction of 12% over three years (see Figure).

Burkhoff noted that about 30% of patients who get a CRT device are nonresponders. Therefore, many patients ultimately progress to NYHA class III and IV. "So as successful as CRT has been, this is not the be-all and end-all of treating heart failure," he said.

ICDs

In a discussion about implantable cardioverter defibrillators (ICDs), Burkhoff mentioned two trials that have shown significant improvement in mortality over three to five years of follow-up. The MADIT II trial looked at the effect of prophylactic ICDs in ischemic left ventricular disease (LVEF ≤30%) and found a 31% reduction in the relative risk of mortality among ICD patients compared with those receiving conventional therapy over 20 months of follow-up (HR=0.69; 95% CI, 0.51-0.93).

In the SCD-HeFT trial, ICD therapy was associated with a 23% decrease in risk of death (HR=0.77; 97.5% CI, 0.62-0.96).

"Of course, these therapies do not address the heart failure state per se and patients still persist with symptoms," Burkhoff said.

LVADs

The most important study to look at survival with left ventricular assist devices (LVADs) is the REMATCH study, which Burkhoff said was a "pivotal study in furthering the field of chronic LVAD therapy." REMATCH looked at patients with advanced heart failure, and found better survival with LVADs compared with medical therapy. The rates of survival at one year were 52% in the device group and 25% in the medical therapy group (P=.002); the survival rates at two years were 23% and 8% (P=.09), respectively. At two years and beyond, LVADs are still associated with a significant loss of life, Burkhoff said, demonstrating that LVADs do not prolong life substantially.

Percutaneous ventricular assist devices

Several percutaneous devices currently are approved for short-term support, including TandemHeart and Impella. While these devices have been shown to improve hemodynamics, Burkhoff said, there are still a lot of questions surrounding their clinical utility and whether they really impact patient outcomes, especially for acute cardiogenic shock.

Burkhoff concluded that "because [most current] therapies are only applicable to a small number of patients, there currently is a large underserved patient population that suffers major symptoms and major risks. This is the population that has been the focus of new device innovations."

Disclosures:

Dr. Burkhoff reports receiving consulting fees/honoraria from Cheetah Medical and Accelerated Technologies, Inc; salary support from Impulse Dynamics; and is a stockholder of or has equity in Impulse Dynamics, Cheetah Medical, GDS, Arstasis, CircuLite, Abiomed, and Pathway Medical.

（source：www.tctmd.com）