International Circulation: Acute heart failure syndromes remain a major threat to both patients and also a difficult issue for doctors. Could you please give us a brief summary of the latest advance in this area?

《国际循环》:急性心力衰竭症候群仍是患者的一个主要的威胁也是医生的一个难题。能请您简要总结一下该领域的最新进展吗？

Christopher O’Connor:  It was really nicely pointed out that heart failure syndromes are really a major healthcare problem not only in the United States but across the globe.  It is the number one reason for hospitalizations of patients over the age of 65.  It is one of the largest contributors to morbidity and mortality of acute cardiac conditions.  It is associated with an enormous economic burden with long lengths of stay and a lot of costs in the delivery of care.  The challenges to improve therapy and improve outcomes are very important.  What people don’t realize is that acute heart failure syndrome actually is associated with a very significant morbidity and mortality so for the past decade we have been trying to institute therapies， mostly pharmacologic and others， to reduce that risk.  It has been a considerable challenge to make that work.  We have looked at inotropic agents， we’ve looked at vasodilators， at strategies with PAC catheters， neurohormonal modulators， and other strategies such as iono-dilators， but nothing has really provided an important benefit.  What I think is exciting are two points， one is that we are finally getting to the point where we are doing clinical studies that are large enough that we can be confident with our results.  The problem is that earlier we were doing small trials and were confused with the data.  For example， the ASCEND trial， which we are coordinating at the Duke Clinical Research Institute， is a 7000 patient global study of Nesiritide in decompensated acute heart failure and those results will be available this time next year.  We will learn a lot about the drug and about the condition of acute heart failure.  Some of the promising strategies include some novel approaches， you may have heard of a new neurohormonal strategy with a drug which is a naturally occurring peptide hormone， which normally appears during pregnancy.  It increases cardiac index and also improves renal function.  It is currently being studied in acute heart failure Phase II studies.  We also have seen the potential role of ultrafiltration， a device strategy with removing fluid more aggressively and maybe more safely than diuretic therapy.  The data from larger studies currently underway is very encouraging.  I think there is hope that we will be able to make an impact.  Perhaps other novel compounds being studied in this condition but there is a lot of work to be done.

Christopher O’Connor: 指出心力衰竭症候群不仅是美国也是全球主要的健康问题，这很好。这是65岁以上患者入院的头号原因，是急性心脏疾病的发病率和病死率的最大贡献者之一，因其病程长和护理的花销大带来巨大的经济负担。改善治疗和预后及其重要。人们未认识到是急性心力衰竭症候群实际上与高发病率和病死率相关，因此在过去的几十年里我们一直致力于制定治疗方法，主要是药物和其他以降低风险。这项工作挑战性极大。我们审视了影响收缩力的物质，血管扩张剂，PAC导管策略，神经激素调节器和其他策略如电离扩张器， 但没有真正能有重要成效的。我认为让人兴奋的有两点：一点是我们终于能开始规模大的足够让我们对结果有信心临床试验。问题是之前我们进行的小型试验数据很混杂。例如，我们与杜克临床研究所合作的ASCEND试验， 是一个7000名患者参与的关于奈西立肽对代偿失调性急性心衰影响的全球性研究，明年这个时候可以得到结果。我们会对药物和急性心力衰竭的情况有大量的了解。一些很有前景的策略包括一些新的方法。你或许听说过一种新的神经激素策略，药物的名字叫做达拉辛， 是一个自然产生的多肽，通常在孕期出现。它能提高心脏指数和改善肾功能。急性心力衰竭阶段II研究正对此进行研究。我们也看到了超滤的潜力，更强有力的去除液体的设备策略或许比利尿剂治疗更安全。正在进行的更大规模的研究令人鼓舞。我认为有希望能产生影响。或许在这种情况下也在研究其他新型的复合物，但这需要做大量的工作。