Objective To investigate the risk factors associated with combined post-capillary and pre-capillary pulmonary hypertension(Cpc-PH)and the prognostic difference between isolated post-capillary pulmonary hypertension(Ip...Objective To investigate the risk factors associated with combined post-capillary and pre-capillary pulmonary hypertension(Cpc-PH)and the prognostic difference between isolated post-capillary pulmonary hypertension(Ipc-PH)and Cpc-PH in pulmonary hypertension due to left heart failure.Methods From October 2012 to November 2016,patients with pulmonary hypertension due to heart failure with preserved ejection fraction(PH-HFpEF)and pulmonary hypertension due to heart failure with reduced ejection fraction(PH-HFrEF)were prospectively enrolled from 11 centers all over the country.展开更多
目的再评价肺静脉隔离(PVI)联合肾交感神经消融术(RDN)治疗心房颤动(以下简称房颤)合并高血压的系统评价。方法计算机检索PubMed、Cochrane Library、Web of Science、万方数据知识服务平台、中国知网、维普网发表的PVI联合RDN治疗房颤...目的再评价肺静脉隔离(PVI)联合肾交感神经消融术(RDN)治疗心房颤动(以下简称房颤)合并高血压的系统评价。方法计算机检索PubMed、Cochrane Library、Web of Science、万方数据知识服务平台、中国知网、维普网发表的PVI联合RDN治疗房颤合并高血压的系统评价,检索时限均为建库至2022-03-31。由两名研究员严格按照文献纳入与排除标准独立筛选和提取资料,然后采用PRISMA声明、AMSTAR2量表和GRADE方法分别评价纳入文献的报告质量、方法学质量和结局指标的证据质量。结果9篇文献的报告质量平均得分为16.5分,其中最高分22.0分、最低分11.0分;其中高质量报告1篇,中等质量报告5篇,低质量报告3篇。4篇文献的方法学质量等级为低质量,5篇文献的方法学质量等级为极低质量。9篇文献的结局指标共27个证据体,其中高质量证据体2个(7.4%),中等质量证据体6个(22.2%),低质量证据体14个(51.9%),极低质量证据体5个(18.5%)。系统评价结果显示,试验组患者房颤复发率低于对照组(P<0.05)(证据等级为低、中等、高)。试验组患者诊室收缩压、诊室舒张压降低幅度均大于对照组(P<0.05)(证据等级为低、中等);试验组患者动态收缩压、动态舒张压降低幅度均大于对照组(P<0.05)(证据等级为极低)。试验组与对照组并发症发生率比较,差异无统计学意义(P>0.05)(证据等级为极低、低、中等)。试验组患者估算肾小球滤过率(eGFR)高于对照组(P<0.05)(证据等级为低)。试验组患者左心室舒张末期内径(LVEDD)、左心室质量指数(LVMI)下降幅度大于对照组(P<0.05)(证据等级为极低)。结论该研究纳入的系统评价报告质量较高,但其结局指标证据质量偏低。PVI联合RDN可有效降低房颤合并高血压患者术后房颤复发率,提高患者降压效果,且安全性较高。展开更多
Objective:The Pulmonary Arterial Denervation in Patients With Pulmonary Hypertension Associated With the Left Heart Failure(PADN-5)study proved that pulmonary artery denervation(PADN)is associated with significant imp...Objective:The Pulmonary Arterial Denervation in Patients With Pulmonary Hypertension Associated With the Left Heart Failure(PADN-5)study proved that pulmonary artery denervation(PADN)is associated with significant improvements in hemodynamic and clinical outcomes in patients with combined pre-and post-capillary pulmonary hypertension(CpcPH).This study aimed to assess the 3-year clinical results of PADN in patients who had heart failure with preserved ejection fraction(HFpEF)developing into CpcPH(HFpEF-CpcPH).Methods:In this post hoc analysis of the PADN-5 trial,38 patients with HFpEF were included in screening out of 98 patients with CpcPH who were randomly assigned to treatment with sildenafil and sham PADN(sham PADN(plus sildenafil)group,abbreviated as sham group)or PADN(PADN group).HFpEF in the PADN-5 trial was defined as a left ventricular ejection fraction≥50%,and CpcPH was defined as a mean pulmonary arterial pressure≥25 mmHg,a pulmonary arterial wedge pressure>15 mmHg,and a pulmonary vascular resistance>3.0 WU.The changes in the 6-minute walk distance(6-MWD)and the plasma concentration of N-terminal pro-brain natriuretic peptide(NT-proBNP)at 6-month and 3-year follow-up,as well as the clinical endpoint of the occurrence of clinical worsening,defined as cardiopulmonary-related death,rehospitalization,or heart or lung transplantation at 3-year follow-up were examined.Results:Thirty-eight patients with HFpEF-CpcPH were assigned to the PADN group(n=19)or the sham group(n=19).At the 6-month follow-up,6-MWD(433(275,580)m vs.342(161,552)m),and reductions in NT-proBNP(−47%(−99%,331%)vs.−12%(−82%,54%))were significantly improved in the PADN group(all P<0.05).Over the 3-year follow-up period,PADN treatment resulted in marked increases in 6-MWD(450(186,510)m vs.348(135,435)m)and reductions in NT-proBNP(−55%(−99%,38%)vs.−10%(−80%,95%))(all P<0.05).Clinical worsening was experienced by 12 patients(63%)in the sham group,but by only 5 patients(26%)in the PADN group(hazard ratio=0.149,95%confidence interval:0.038–0.584,P=0.006).The 6-MWD and PADN treatments were independent predictors of clinical deterioration in patients with HFpEF-CpcPH.Conclusions:PADN therapy is associated with improvements in exercise capacity and clinical outcomes.PADN therapy may have a potential role in patients with HFpEF-CpcPH for whom current treatment options are limited.展开更多
目的:通过Meta分析方法评价肺静脉隔离(PVI)联合肾交感神经消融术(RDN)治疗心房颤动(房颤)合并高血压患者的有效性及安全性。方法:在Cochrane Library、PubMed、EMBASE、中国知网及万方数据库中,检索自建库至2020年10月发表的关于PVI联...目的:通过Meta分析方法评价肺静脉隔离(PVI)联合肾交感神经消融术(RDN)治疗心房颤动(房颤)合并高血压患者的有效性及安全性。方法:在Cochrane Library、PubMed、EMBASE、中国知网及万方数据库中,检索自建库至2020年10月发表的关于PVI联合RDN与单独PVI治疗房颤合并高血压的临床研究,经筛选后用于Meta分析。主要结局指标为房颤复发、血压下降的幅度、左心功能改变[左室舒张末期内径(LEVDD)、左室重量指数(LV mass index)]、手术时间、透视时间、并发症的发生率。采用Rev Man 5.3统计分析软件进行数据处理。采用TSA 0.9软件对术后房颤复发率等进行试验序贯分析。结果:总共纳入7篇临床试验,共纳入734例患者,RDN+PVI较单纯PVI房颤复发率明显下降(OR=0.41,95%CI0.30~0.56,P<0.01),血压下降幅度更大(收缩压:WMD=-10.94,95%CI-16.43~-5.45,P<0.01;舒张压:WMD=-5.39,95%CI-8.84~-1.94,P<0.01),左心功能改变更显著(LEVDD:WMD=-3.96,95%CI-5.34~-2.58,P<0.01;LV mass index:WMD=-13.35,95%CI-19.08~-7.62,P<0.01),手术时间(WMD=24.96,95%CI20.36~29.56,P<0.01)、透视时间(WMD=5.59,95%CI3.31~7.86,P<0.01)也相应延长,但并发症的发生率差异无统计学意义(P>0.05)。试验序贯分析提示,PVI联合RDN在降低房颤复发率及血压下降上证据确切。结论:与单纯PVI相比,PVI联合RDN在治疗房颤合并高血压患者,可在一定程度上降低术后房颤复发率及更好地控制患者血压、改善左心功能,且并不增加患者相关并发症的发生率。展开更多
文摘Objective To investigate the risk factors associated with combined post-capillary and pre-capillary pulmonary hypertension(Cpc-PH)and the prognostic difference between isolated post-capillary pulmonary hypertension(Ipc-PH)and Cpc-PH in pulmonary hypertension due to left heart failure.Methods From October 2012 to November 2016,patients with pulmonary hypertension due to heart failure with preserved ejection fraction(PH-HFpEF)and pulmonary hypertension due to heart failure with reduced ejection fraction(PH-HFrEF)were prospectively enrolled from 11 centers all over the country.
文摘目的再评价肺静脉隔离(PVI)联合肾交感神经消融术(RDN)治疗心房颤动(以下简称房颤)合并高血压的系统评价。方法计算机检索PubMed、Cochrane Library、Web of Science、万方数据知识服务平台、中国知网、维普网发表的PVI联合RDN治疗房颤合并高血压的系统评价,检索时限均为建库至2022-03-31。由两名研究员严格按照文献纳入与排除标准独立筛选和提取资料,然后采用PRISMA声明、AMSTAR2量表和GRADE方法分别评价纳入文献的报告质量、方法学质量和结局指标的证据质量。结果9篇文献的报告质量平均得分为16.5分,其中最高分22.0分、最低分11.0分;其中高质量报告1篇,中等质量报告5篇,低质量报告3篇。4篇文献的方法学质量等级为低质量,5篇文献的方法学质量等级为极低质量。9篇文献的结局指标共27个证据体,其中高质量证据体2个(7.4%),中等质量证据体6个(22.2%),低质量证据体14个(51.9%),极低质量证据体5个(18.5%)。系统评价结果显示,试验组患者房颤复发率低于对照组(P<0.05)(证据等级为低、中等、高)。试验组患者诊室收缩压、诊室舒张压降低幅度均大于对照组(P<0.05)(证据等级为低、中等);试验组患者动态收缩压、动态舒张压降低幅度均大于对照组(P<0.05)(证据等级为极低)。试验组与对照组并发症发生率比较,差异无统计学意义(P>0.05)(证据等级为极低、低、中等)。试验组患者估算肾小球滤过率(eGFR)高于对照组(P<0.05)(证据等级为低)。试验组患者左心室舒张末期内径(LVEDD)、左心室质量指数(LVMI)下降幅度大于对照组(P<0.05)(证据等级为极低)。结论该研究纳入的系统评价报告质量较高,但其结局指标证据质量偏低。PVI联合RDN可有效降低房颤合并高血压患者术后房颤复发率,提高患者降压效果,且安全性较高。
基金supported by the National Scientific Foundation of China(82100438,82270436,and 82121001).
文摘Objective:The Pulmonary Arterial Denervation in Patients With Pulmonary Hypertension Associated With the Left Heart Failure(PADN-5)study proved that pulmonary artery denervation(PADN)is associated with significant improvements in hemodynamic and clinical outcomes in patients with combined pre-and post-capillary pulmonary hypertension(CpcPH).This study aimed to assess the 3-year clinical results of PADN in patients who had heart failure with preserved ejection fraction(HFpEF)developing into CpcPH(HFpEF-CpcPH).Methods:In this post hoc analysis of the PADN-5 trial,38 patients with HFpEF were included in screening out of 98 patients with CpcPH who were randomly assigned to treatment with sildenafil and sham PADN(sham PADN(plus sildenafil)group,abbreviated as sham group)or PADN(PADN group).HFpEF in the PADN-5 trial was defined as a left ventricular ejection fraction≥50%,and CpcPH was defined as a mean pulmonary arterial pressure≥25 mmHg,a pulmonary arterial wedge pressure>15 mmHg,and a pulmonary vascular resistance>3.0 WU.The changes in the 6-minute walk distance(6-MWD)and the plasma concentration of N-terminal pro-brain natriuretic peptide(NT-proBNP)at 6-month and 3-year follow-up,as well as the clinical endpoint of the occurrence of clinical worsening,defined as cardiopulmonary-related death,rehospitalization,or heart or lung transplantation at 3-year follow-up were examined.Results:Thirty-eight patients with HFpEF-CpcPH were assigned to the PADN group(n=19)or the sham group(n=19).At the 6-month follow-up,6-MWD(433(275,580)m vs.342(161,552)m),and reductions in NT-proBNP(−47%(−99%,331%)vs.−12%(−82%,54%))were significantly improved in the PADN group(all P<0.05).Over the 3-year follow-up period,PADN treatment resulted in marked increases in 6-MWD(450(186,510)m vs.348(135,435)m)and reductions in NT-proBNP(−55%(−99%,38%)vs.−10%(−80%,95%))(all P<0.05).Clinical worsening was experienced by 12 patients(63%)in the sham group,but by only 5 patients(26%)in the PADN group(hazard ratio=0.149,95%confidence interval:0.038–0.584,P=0.006).The 6-MWD and PADN treatments were independent predictors of clinical deterioration in patients with HFpEF-CpcPH.Conclusions:PADN therapy is associated with improvements in exercise capacity and clinical outcomes.PADN therapy may have a potential role in patients with HFpEF-CpcPH for whom current treatment options are limited.
文摘目的:通过Meta分析方法评价肺静脉隔离(PVI)联合肾交感神经消融术(RDN)治疗心房颤动(房颤)合并高血压患者的有效性及安全性。方法:在Cochrane Library、PubMed、EMBASE、中国知网及万方数据库中,检索自建库至2020年10月发表的关于PVI联合RDN与单独PVI治疗房颤合并高血压的临床研究,经筛选后用于Meta分析。主要结局指标为房颤复发、血压下降的幅度、左心功能改变[左室舒张末期内径(LEVDD)、左室重量指数(LV mass index)]、手术时间、透视时间、并发症的发生率。采用Rev Man 5.3统计分析软件进行数据处理。采用TSA 0.9软件对术后房颤复发率等进行试验序贯分析。结果:总共纳入7篇临床试验,共纳入734例患者,RDN+PVI较单纯PVI房颤复发率明显下降(OR=0.41,95%CI0.30~0.56,P<0.01),血压下降幅度更大(收缩压:WMD=-10.94,95%CI-16.43~-5.45,P<0.01;舒张压:WMD=-5.39,95%CI-8.84~-1.94,P<0.01),左心功能改变更显著(LEVDD:WMD=-3.96,95%CI-5.34~-2.58,P<0.01;LV mass index:WMD=-13.35,95%CI-19.08~-7.62,P<0.01),手术时间(WMD=24.96,95%CI20.36~29.56,P<0.01)、透视时间(WMD=5.59,95%CI3.31~7.86,P<0.01)也相应延长,但并发症的发生率差异无统计学意义(P>0.05)。试验序贯分析提示,PVI联合RDN在降低房颤复发率及血压下降上证据确切。结论:与单纯PVI相比,PVI联合RDN在治疗房颤合并高血压患者,可在一定程度上降低术后房颤复发率及更好地控制患者血压、改善左心功能,且并不增加患者相关并发症的发生率。
