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首页> 外文期刊>European Journal of Translational Myology >Demand dynamic cardiomyoplasty. Improved clinical benefits by non-invasive monitoring of LD flap and long-term tuning of its dynamic contractile characteristics by activity-rest regime
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Demand dynamic cardiomyoplasty. Improved clinical benefits by non-invasive monitoring of LD flap and long-term tuning of its dynamic contractile characteristics by activity-rest regime

机译：要求动态心肌成形术。通过无创监测LD皮瓣并通过活动休息制度长期调整其动态收缩特性来改善临床疗效

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To many authors, cardiomyoplasty is a clinical reality, founded on the basis of its girdling effect which limits and/or reverses the progressive dilatation of a failing heart. Load-independent measurements of cardiac function demonstrate a real improvement of the heart energetics when analyses are compared before and after cardiomyoplasty. Standard indices of systolic function are not consistently improved. One of the factors limiting the systolic assistance of cardiomyoplasty is muscle performance after full conditioning of LD. Clinically, it is accepted that LD benefits the patient's quality of life only if its activation is optimally delayed after the sensed QRS complex in order to avoid mitral regurgitation. Since maximum instantaneous power of a fully conditioned LD is smaller than the peak power of the left ventricle, the grafted muscle could assist the heart during mid and late systolic phases. Such a short time window requires a fast, powerful contraction which is not delivered by a fully transformed LD. Monitoring LD function is essential for evaluating and implementing new concepts aimed at improving LD function for greater systolic benefit. We have developed a simple non-invasive method to analyse the dynamic characteristics of the LD flap during conditioning and chronic stimulation using a standard polygraph. To perform this monitoring we have implemented the basic concept of tetanic fusion frequency analysis. By monitoring changes in fusion frequency over time, we hoped that it would be possible to adjust daily stimulation parameters in order to maintain a faster, more powerful muscle. In fact, this has now been achieved by implementing an activity-rest regime. After months of continuous daily stimulation it is possible to reverse the fast-to-slow transformation by a demand stimulation protocol which allows the LD flap to rest during periods of low-activity, both day and night. With this lighter stimulation regime, now used in patients at more than one-year of follow-up, substantial improvement in quality of life has occurred with a reduction in heart failure symptoms from N.Y.H.A. Class III to I. If these preliminary data can be substantiated by long-term results in these patients and in future patients in an Italian Trial of Demand Dynamic Cardiomyoplasty (DDC), we are confident that DDC could offer long-standing benefits to manage pharmacologically-intractable heart failure.
机译：对许多作者而言，心肌成形术是一种临床现实，建立在其环剥作用的基础上，环剥作用限制和/或逆转了衰竭心脏的进行性扩张。当在心肌成形术之前和之后进行分析比较时，心脏功能的独立于负荷的测量结果显示了心脏能量的真正改善。收缩功能的标准指标并未得到持续改善。限制心肌成形术收缩辅助的因素之一是完全调节LD后的肌肉性能。临床上，只有在感觉到QRS波复合体后，为了避免二尖瓣关闭不全，其激活被最佳延迟，LD才可以使患者的生活质量得到改善。由于完全适应性LD的最大瞬时功率小于左心室的峰值功率，因此移植的肌肉可以在心脏收缩的中期和晚期协助心脏。如此短的时间窗口要求快速，有力的收缩，而这是完全转换后的LD无法实现的。监视LD功能对于评估和实施旨在改善LD功能以获得更大收缩压的新概念至关重要。我们已经开发了一种简单的非侵入性方法，可以使用标准测谎仪分析条件调节和慢性刺激过程中LD皮瓣的动态特征。为了执行此监视，我们已经实现了破伤风融合频率分析的基本概念。通过监测融合频率随时间的变化，我们希望可以调整每日刺激参数，以保持更快，更强大的肌肉。实际上，现在已经通过实施活动休息制度来实现这一目标。在连续数月的每日刺激后，可以通过需求刺激方案逆转快速至缓慢的转变，该方案允许LD皮瓣在白天和黑夜的低活动期休息。通过这种较轻的刺激方案，现在已在患者进行了一年以上的随访，生活质量有了实质性改善，同时因N.Y.H.A.引起的心力衰竭症状有所减轻。 I至III类。如果这些初步数据可以通过这些患者以及将来的意大利需求动态心肌成形术（DDC）试验中的长期结果得到证实，那么我们相信DDC可以为药物治疗带来长期的益处-顽固性心力衰竭。

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