International Circulation: Given the vast array of devices currently available， which are you most excited about?
　　国际循环：现有的设备种类如此繁多，您对哪种设备最感兴趣呢？
　　Dr. William Abraham: I think at this moment， because it is on the near horizon is Cardiac contractilit modulation . This is a form of electrical therapy for the heart which could be applied to up to 70% of heart failure patients including those patients with a narrow QRS complex， which do not have an indication for CRT.
　　William Abraham医生：我认为，在此时此刻我会选择最近新兴的心脏收缩调制。这是一种针对心脏的电刺激疗法，几乎可以适用于70%的心衰患者，包括那些QRS波群狭窄不具有CRT疗法适应症的患者。
　　International Circulation: What are the indications to which you can apply this therapy?
　　国际循环：您认为，应用这一疗法的适应症是什么？
　　Dr. William Abraham: Cardiac contractilit modulation is currently investigational in targeting patients with moderate LV systolic dysfunction， injection fractions between 25 and 45% and patients with moderate symptoms including those grouped in New York Medical Association Class 3 patients.
　　William Abraham医生：目前心脏收缩调制的目标人群为中度左室收缩功能障碍，射血分数在25%-45%且具有中度症状的患者，包括那些按照纽约医学会分级为3级的患者。
　　International Circulation: Compared to therapy alone do you recommend cardio-resynchronization therapy?
　　国际循环:单纯比较疗法的话，您建议使用心脏同步化疗法吗？
　　Dr. William Abraham: Certainly， cardio-resynchronization therapy is complimentary to drugs alone. All the guidelines has shown that we should first optimize our therapy regimens， if patients remain symptomatic or continue to exhibit low ejection fractions or with a wide QRS complex should receive cardio-resynchronization therapy.
　　William Abraham医生：当然，心脏同步化疗法优于单纯药物疗法。所有的指南都显示，如果患者仍然有症状或者持续表现为低射血分数或者QRS波群宽应该接受心脏同步化疗法时，我们首先应该优化我们的治疗方案。
　　International Circulation: Malignancy arrhythmia is the most common complication in heart failure. The MUSTT study showed ICD vs. absence of ICD decreased the relative risk of cardiac arrest or arrhythmic mortality in heart failure patients. In consideration of cost， would you firstly this avenue as the first line therapy option.
　　国际循环：恶性心律失常是心衰最常见的并发症。MUSTT研究显示，采用ICD与不采用ICD相比，降低了心衰患者发生心跳骤停或心律失常性死亡的相对危险性。如果考虑到成本的话，您会将这种将这种疗法列为一线治疗选择吗？
　　Dr. William Abraham:  The weight of evidence supporting the use of an ICD in heart failure patients is really quite strong. In addition to the MUSTT study there are other studies such as SCD-HeFT and the DEFINITE Trial have both shown conclusively of the benefit of life saving capacities of ICDs for heart failure patients. These devices have a class 1 indication. However， the important thing I want to emphasize is that we should first optimize drug therapy， if patients remain mildly or moderately symptomatic with low ejection fractions then they will be candidates for ICD.
　　William Abraham医生：强有力的证据支持在心衰患者中使用ICD治疗。其实，除了MUSTT研究还有其他研究，比如SCD-HeFT研究也显示对于心衰患者来说，ICD治疗在挽救患者生命方面具有绝对性的疗效。这种设备具有一级适应症。然而，我想强调的重点是我们应该首先优化药物疗法，如果患者仍然具有轻度或中度症状且射血分数低的话，他们则应该采用ICD疗法。
　　International Circulation: What are the indications of artificial heart and ventricular assist for heart failure patients?
　　国际循环：对于心衰患者来说，人工心脏和心室辅助疗法的适应症是什么？
　　Dr. William Abraham: Today we use these devices primarily as a bridge towards transplantation. For example if we have a transplant candidate but who is too sick to make it there， without one of these devices is a candidate for one of these devices. In addition， there is another setting to which we can use these devices. This does not involve transplantation and is termed so called “destination therapy” where we use these devices for end-stage heart failure patients collectively referred to as stage D patients.
　　William Abraham医生：今天，我们使用这种设备主要是为心脏移植进行一个过渡。比如，我们有一个需要心脏移植的患者，但是他病的太重无法接受手术，这种患者就可以采用这一设备。另外，还有一种情况我们也会使用这一设备。这与心脏移植没有关系，即所谓的“终点治疗服务”，在这里我们将这种设备用于终末期心衰患者，即D期患者。
　　International Circulation: Do infection and thromboembolic complications still limit their usage?
　　国际循环：感染和血栓栓塞并发症仍会限制其使用吗？
　　Dr. William Abraham: Infections and thromboembolic complications do limit the use of artificial hearts. This is because that although these mechanical devices do improve heart failure， there is an increased risk of debilitating consequences for the patient.
　　William Abraham医生：感染和血栓栓塞并发症的确会限制人工心脏的应用。这是因为，尽管这种机械设备能够改善心衰状态，也会使患者虚弱的风险增大。
　　International Circulation: One more intriguing device you mentioned was spinal cord stimulation in heart failure， can you please offer your opinions on its usage?
　　国际循环：您提到的另一种更有趣的装置是针对心衰患者的脊髓电刺激疗法，您能对这一疗法的应用谈一谈您的看法吗？
　　Dr. William Abraham: Spinal cord stimulation is a therapeutic avenue which can be used to manage chronic pain and there is also some data showing that it shows benefits in patients with refractory angina. Because ，it affects the spinal cord to the heart it can also alter autonomic signals to the heart， we susoect it will have a favorable effect on heart failure. This proof of concept has been shown in an animal canine model and human studies are now underway. The way it works is that it provides an electrical pulse stimulation to the spinal cord causing stimulation of the nerves， either turning on or turning off sympathetic blood flow to heart.
　　William Abraham医生：脊髓电刺激这种疗法可以用来控制长期疼痛，还有一些数据显示，它能为顽固性心绞痛患者带来福音，因为它能影响支配心脏的脊髓神经，也能够改变心脏的自主神经信号。我们推测它对心衰的治疗能够带来有利影响。这一观点已经在犬类动物模型中到了验证，相关的人体研究正在进行中。这种疗法的作用方式如下，通过提供电脉冲来刺激脊髓引起神经刺激，进而打开或者关闭使血液流向心脏。