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Heart Rhythm:心脏再同步化治疗远期死亡率变异颇大

2012-12-05 高晓方译 Heart Rhythm

心律转复除颤器心脏再同步化治疗死亡率左束支传导阻滞
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　　　 　　美国学者的一项研究表明，心律转复除颤器（CRT-D）再同步化治疗之后，远期死亡率依据基线传导缺陷和重塑反应而存在较大变异。论文于2012年11月26日在线发表于《心律》（Heart Rhythm）杂志。 　　此项研究对MADIT-CRT亚组患者进行了评估。MADIT-CRT对1820例接受心脏再同步除颤器（CRT-D）或仅除颤器（ICD）治疗的患者进行了比较。在左束支传导

　　心脏再同步化治疗　

　　美国学者的一项研究表明，心律转复除颤器（CRT-D）再同步化治疗之后，远期死亡率依据基线传导缺陷和重塑反应而存在较大变异。论文于2012年11月26日在线发表于《心律》（Heart Rhythm）杂志。

　　此项研究对MADIT-CRT亚组患者进行了评估。MADIT-CRT对1820例接受心脏再同步除颤器（CRT-D）或仅除颤器（ICD）治疗的患者进行了比较。在左束支传导阻滞（LBBB）和非LBBB的患者中，利用Cox比例回归分析评估治疗效果对死亡率的影响。在1196例于1年时复查超声心动图的患者中，通过基线传导和1年左室收缩末期容积（LVESV）变化分析CRT-D对远期死亡率的影响。

　　结果显示，CRT-D未降低总体死亡率（P=0.72）。在伴LBBB和CRT-D的761例患者中，对临床协变量进行校正之后死亡率呈降低趋势。在出现（有效者）和未出现（无效者）LVESV减小≥30%的患者中进一步评估CRT-D对死亡率的影响。CRT-D显著降低了LBBB有效者的死亡率（P=0.027），LBBB无效者则无此效应。与之相反，CRT-D使非LBBB有效者的死亡率出现升高趋势；非LBBB无效者的死亡率则显著升高（P=0.011）。



Objectives
To clarify influences on long-term mortality after cardiac resynchronization therapy with implantable defibrillator (CRT-D), we assessed MADIT-CRT patient outcomes by baseline conduction abnormality and one-year post-treatment remodeling.
Background
Long-term mortality data after CRT-D in minimally symptomatic patients are limited.
Methods
MADIT-CRT followed 1820 patients assigned to CRT-D or defibrillator (ICD)-only. Using Cox proportional regression analysis, treatment effects (CRT-D vs. ICD-only) on mortality were evaluated in patients with left bundle branch block (LBBB) and non-LBBB. Among 1196 patients with echocardiography repeated at one year, effect of CRT-D on later mortality (landmark analysis) was analyzed by baseline conduction and one-year change in left ventricular end-systolic volume (LVESV).
Results
Overall mortality was not reduced by CRT-D: hazard ratio (HR) for CRT-D: ICD-only = 0.94, p=0.72. Among 761 patients with LBBB and CRT-D, mortality trended lower (HR 0.71, p=0.10) after adjustment for clinical covariates. Effect of CRT-D on mortality was further evaluated in patients who did (responders) and did not (hypo-responders) have reduction in LVESV by ≥30%. LBBB responders (n=323) had significantly reduced mortality with CRT-D: HR 0.36, p=0.027; LBBB hypo-responders (n=182) did not (HR 0.99). By contrast, non-LBBB responders (n=89) trended towards more deaths with CRT-D: HR 2.11, p=0.22. Non-LBBB hypo-responders (n=118) had significantly worsened mortality: HR 3.72, p=0.011.
Conclusion
In MADIT-CRT, late mortality with CRT-D varied markedly with baseline conduction defect and remodeling response. Patients with both LBBB and substantially reduced LVESV had improved mortality. Those with non-LBBB or with LBBB and less-reduced LVESV had unchanged or worsened mortality after CRT-D.                  

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    2013-09-28 ms9651749636653578

    #心脏再同步化#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1706297, encodeId=83b81e06297b0, content=<a href='/topic/show?id=59755143397' target=_blank style='color:#2F92EE;'>#心脏再同步化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51433, encryptionId=59755143397, topicName=心脏再同步化)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=728231200390, createdName=ms9651749636653578, createdTime=Sat Sep 28 05:00:00 CST 2013, time=2013-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1342261, encodeId=c0e513422613a, content=<a href='/topic/show?id=34cb381023e' target=_blank style='color:#2F92EE;'>#变异#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38102, encryptionId=34cb381023e, topicName=变异)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=78c32500188, createdName=12498dabm77暂无昵称, createdTime=Fri Dec 07 05:00:00 CST 2012, time=2012-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355711, encodeId=eb2f1355e11db, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Dec 07 05:00:00 CST 2012, time=2012-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562125, encodeId=5b3e1562125c0, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Fri Dec 07 05:00:00 CST 2012, time=2012-12-07, status=1, ipAttribution=)]
    2012-12-07 12498dabm77暂无昵称

    #变异#

    0

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    2012-12-07 zhaojie88

    #ART#

    0

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    2012-12-07 slcumt

    #HEART#

    0