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首页> 外文期刊>Progress in Cardiovascular Diseases >Medical Management Is The Way To Go For Ventricular Reconstruction Post STICH?
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Medical Management Is The Way To Go For Ventricular Reconstruction Post STICH?

机译:针刺后心室重构的医疗管理方法是什么?

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摘要

Ventricular remodeling is a complex process mediated by pathogenic factors all of which interact at the cellular, ventricular and systemic levels to cause progressive left ventricular dilation and subsequently a heart failure syndrome. Remodeling is a well-characterized response to insult or injury and is initiated early on by neurohormonal activation. Neurohormonal antagonists have formed the foundation of therapy to alter the progression of remodeling and concomitantly improve outcomes. Surgical ventricular reconstruction was designed as a surgical means to reduce the ventricular radius and in principal decrease ventricular wall stress as defined by the Law of Laplace. Despite optimistic initial results from case series, the Surgical Treatment for Ischemic Heart Failure Trial (STICH) trial, a large randomized trial of ventricular reconstruction in addition to coronary artery bypass surgery (CABG) therapy for management of patients with heart failure with a reduced ejection fraction showed no clinical benefit. We will summarize the evidence that demonstrates the foundational role of neurohormonal blockade in improving outcomes in patients with heart failure with a reduced ejection and the evidence behind its role in "medical ventricular reconstruction".
机译:心室重构是由致病因子介导的复杂过程,所有这些致病因子均在细胞,心室和全身水平相互作用,引起进行性左心室扩张,继而引起心力衰竭综合征。重塑是对损伤或损伤的充分表征的反应,并在早期通过神经激素激活而开始。神经激素拮抗剂已形成改变重塑进展并随之改善预后的治疗基础。根据拉普拉斯定律,外科手术室重构被设计为减少室半径并主要降低室壁应力的外科手段。尽管从病例系列中得出了乐观的初步结果,但《缺血性心力衰竭外科治疗试验》(STICH)试验是一项大型的心室重建随机试验,此外还进行了冠状动脉搭桥手术(CABG)治疗以减少射血的心力衰竭患者分数显示无临床益处。我们将总结证明神经激素阻滞在改善射血减少的心力衰竭患者预后中的基础作用的证据,以及其在“医学心室重建”中作用的证据。

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