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Eur Heart J ; 36(34): 2297-309, 2015 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-26082085

RESUMO

AIMS: AUGMENT-HF was an international, multi-centre, prospective, randomized, controlled trial to evaluate the benefits and safety of a novel method of left ventricular (LV) modification with alginate-hydrogel. METHODS: Alginate-hydrogel is an inert permanent implant that is directly injected into LV heart muscle and serves as a prosthetic scaffold to modify the shape and size of the dilated LV. Patients with advanced chronic heart failure (HF) were randomized (1 : 1) to alginate-hydrogel (n = 40) in combination with standard medical therapy or standard medical therapy alone (Control, n = 38). The primary endpoint of AUGMENT-HF was the change in peak VO2 from baseline to 6 months. Secondary endpoints included changes in 6-min walk test (6MWT) distance and New York Heart Association (NYHA) functional class, as well as assessments of procedural safety. RESULTS: Enrolled patients were 63 ± 10 years old, 74% in NYHA functional class III, had a LV ejection fraction of 26 ± 5% and a mean peak VO2 of 12.2 ± 1.8 mL/kg/min. Thirty-five patients were successfully treated with alginate-hydrogel injections through a limited left thoracotomy approach without device-related complications; the 30-day surgical mortality was 8.6% (3 deaths). Alginate-hydrogel treatment was associated with improved peak VO2 at 6 months-treatment effect vs. CONTROL: +1.24 mL/kg/min (95% confidence interval 0.26-2.23, P = 0.014). Also 6MWT distance and NYHA functional class improved in alginate-hydrogel-treated patients vs. Control (both P < 0.001). CONCLUSION: Alginate-hydrogel in addition to standard medical therapy for patients with advanced chronic HF was more effective than standard medical therapy alone for improving exercise capacity and symptoms. The results of AUGMENT-HF provide proof of concept for a pivotal trial. TRIAL REGISTRATION NUMBER: NCT01311791.


Assuntos
Alginatos/administração & dosagem , Insuficiência Cardíaca/terapia , Hidrogel de Polietilenoglicol-Dimetacrilato/administração & dosagem , Ecocardiografia , Teste de Esforço , Tolerância ao Exercício/fisiologia , Feminino , Ácido Glucurônico/administração & dosagem , Insuficiência Cardíaca/fisiopatologia , Ácidos Hexurônicos/administração & dosagem , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Segurança do Paciente , Estudos Prospectivos , Próteses e Implantes , Qualidade de Vida , Resultado do Tratamento , Caminhada/fisiologia
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