An Exploratory Study on the Effects of Interatrial Shunt for Patients With Heart Failure With Reduced Ejection Fraction
10.3969/j.issn.1000-3614.2024.10.006
- VernacularTitle:心房分流术应用于射血分数降低的心力衰竭患者的探索性研究
- Author:
Sanshuai CHANG
1
;
Wenhui WU
;
Xinmin LIU
;
Zhengming JIANG
;
Yutong KE
;
Qiang LYU
;
Xin DU
;
Jianzeng DONG
;
Guangyuan SONG
Author Information
1. 首都医科大学附属北京安贞医院 心脏瓣膜病介入中心 国家心血管病临床医学研究中心,北京 100029
- Keywords:
heart failure;
interatrial shunt;
right heart catheterization;
pulmonary capillary wedge pressure;
left ventricular ejection fraction
- From:
Chinese Circulation Journal
2024;39(10):989-996
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To explore the effects of interatrial shunt on cardiac function and clinical prognosis of patients with heart failure with reduced ejection fraction(HFrEF). Methods:This study was a prospective single-arm study.From December 2021 to December 2022,15 consecutive patients with HFrEF from Beijing Anzhen Hospital were enrolled in this study.Interatrial shunt was performed with a D-Shant atrial shunt device.Right heart catheterization was performed before and immediately after device implantation,pulmonary capillary wedge pressure(PCWP),mean right atrial pressure(RAP),interatrial gradient pressure,mean pulmonary artery pressure,total pulmonary resistance(TPR),pulmonary vascular resistance(PVR),cardiac index(CI),and pulmonary/systemic blood flow ratio(Qp/Qs)were measured.Patients were followed-up for 12 months after procedure,changes in cardiac structure and function were evaluated by echocardiography.NYHA classification,6-minute walking distance(6MWD),and Kansas City cardiomyopathy questionnaire(KCCQ)were observed.All-cause mortality and rehospitalization for heart failure served as clinical endpoints. Results:Interatrial shunt procedure was successful in all patients.Compared with preoperative value,PCWP,interatrial gradient pressure,mean pulmonary artery pressure,and TPR were significantly decreased,while Qp/Qs was significantly increased immediately after procedure(all P<0.01).There were no significant changes in RAP,PVR,and CI post procedure(all P>0.05).There were no significant differences in shunt size,shunt velocity,and shunt pressure difference between postoperative immediately and at 12-months follow-up(all P>0.05).At 12 months,left ventricular ejection fraction was significantly higher than baseline level(P<0.05),and there were no significant changes in right atrial diameter and right ventricular fractional area change(both P>0.05).Compared with preoperative status,NYHA classification was improved,KCCQ score was increased,and the number of patients with 6MWD>450 m was increased at 12 months(all P<0.05).N-terminal pro-B-type natriuretic peptide value was significantly decreased at 12 months(P<0.05).No patient died during the 12-months follow-up period,and there were no device-related adverse events.Two patients experienced hospital readmission for heart failure. Conclusions:Implantation of interatrial shunt device could effectively improve hemodynamic parameters in patients with HFrEF and is related to significantly improved cardiac function at 12-months follow-up.
