cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2021.10.n1612cardio-1612Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESВлияние имплантации устройства для регуляции предсердного кровотока на параметры гемодинамики у пациентов с сердечной недостаточностьюThe impact of atrial flow regulator implantation on hemodynamic parameters in patients with heart failureБахшалиевНиджадBakhshaliyevNijad

доцент 

assistant professor doctor

bnijad@bezmialem.edu.trОздемирРамазанOzdemirRamazan

профессор

professor doctor

rrozdemirr@bezmialem.edu.trУниверситет Безмалема Вакифа, Стамбул, ТурцияТурцияBezmialem Vakif University, Istanbul, TurkeyTurkey20213010202161107180Copyright © Kardiomag, 20212021KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/1612

Цель   Декомпрессия левого предсердия стала новым методом лечения пациентов с сердечной недостаточностью и одышкой в покое или при физической нагрузке. Мы представляем данные о влиянии имплантации устройства для регуляции предсердного кровотока (AFR) на гемодинамические параметры у пациентов нашего центра с сердечной недостаточностью со сниженной (СНнФВ) или сохраненной фракцией выброса левого желудочка (СНсФВ).Материал и методы    Исследование PRELIEVE предназначено для оценки безопасности и эффективности имплантации устройства для регуляции предсердного кровотока у пациентов с СНнФВ или СНсФВ. В исследование были включены пациенты с конечным диастолическим давлением левого желудочка ≥15 мм рт. ст, измеренным в покое или ≥25 мм рт. ст. - во время физической нагрузки, и с фракцией выброса левого желудочка ≥15%. Эхокардиографические данные, тест шестиминутной ходьбы, результаты заполнения Канзасского опросника для больных кардиомиопатией и уровни мозгового натрийуретического пептида оценивались до и после имплантации AFR и через 3 месяца. Инвазивная оценка гемодинамических параметров также проводилась до и после имплантации AFR и через 3 месяца.Результаты    27 (69,2%) пациентов с СНнФВ и 12 (30,8%) пациентов с СНсФВ были включены в исследование в нашем центре. Значительное снижение давления заклинивания легочной артерии наблюдалось независимо от величины фракции выброса левого желудочка (p = 0,007 для СНнФВ и p = 0,03 для СНсФВ). Не было существенной разницы между средним давлением в легочной артерии, давлением в правом предсердии и величиной сердечного выброса через 3 месяца по сравнению с исходными значениями до имплантации.Заключение    Имплантация устройства для регуляции предсердного кровотока привела к снижению давления наполнения левого желудочка без негативного воздействия на сердечный выброс и функцию правых отделов сердца, независимо от величины фракции выброса левого желудочка.

Background    Left atrial decompression has emerged a new option to treat patients with heart failure and dyspnea at rest or during exercise. Here we report the impact of atrial flow regulator (AFR) implantation on hemodynamic parameters in patients at our center with heart failure and with reduced (HFrEF) or with preserved left ventricular ejection fraction (HFpEF).Material and methods    The PRELIEVE trial is designed to assess the safety and efficacy of the AFR in patients with HFrEF or HFpEF. Patients with left ventricular end-diastolic pressure ≥15 mmHg at rest or ≥25 mmHg during exercise and with an ejection fraction ≥15 % were enrolled. Echocardiographic data, 6‑min walking distance, Kansas City Cardiomyopathy Questionnaire, and brain natriuretic peptide levels were assessed pre- and post-AFR implantation and at 3 mos. Invasive hemodynamic assessments were also performed pre- and post-AFR implantation and at 3 mos.Results    27 (69.2 %) patients with HFrEF and 12 (30.8 %) patients with HFpEF at our center were enrolled in this study. A significant decrease was observed in pulmonary arterial wedge pressure regardless of EF (p=0.007 for HFrEF and p=0.03 for HFpEF). No significant difference of mean pulmonary arterial pressure, right arterial pressure and cardiac output (CO) existed at 3 months compared with pre-implantation baseline values.Conclusion    AFR implantation led to decrease in left ventricle filling pressure without the deleterious impact on CO and right heart function regardless of ejection fraction.

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The authors declare that there are no conflicts of interest present.