左心室シストリック機能不全の患者の心臓再同期療法:体系的なレビュー
Finlay A McAlister1, Justin Ezekowitz, Nicola Hooton
1The University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada. finlay.mcalister@ualberta.ca
JAMA
|June 15, 2007
まとめ
心臓再同期療法 (CRT) は,左心室収縮性機能不全と心不全症状を有する患者の罹病率と死亡率を著しく減少させます. この治療は,最適な薬剤療法と組み合わせると,心臓の機能,生活の質,生存率を改善します.
科学分野:
- 心臓病学 心臓病学
- 医療機器 医療機器について
- 心不全管理について
背景:
- 左心室 (LV) 収縮機能不全は,罹病率と死亡率の主な原因である.
- 最適な薬剤療法では,すべての患者のニーズを完全に満たすことはできません.
- 心臓再同期療法 (CRT) は,選択された患者に対して2001年にFDAの承認を受けました.
研究 の 目的:
- LVシストリック機能不全の患者におけるCRTの有効性,有効性,および安全性を評価する.
- この患者集団におけるCRTの現在のエビデンスベースを要約します.
主な方法:
- 2006年11月まで,電子データベースと手動検索を体系的に検討する.
- 有効性に関する14件のランダム化試験 (4420人の患者) を含む.
- 効果に関する106件の研究 (9209人の患者) と安全性に関する89件の研究 (9677人の患者) を含む.
主要な成果:
- 患者は,LVシストリック機能不全 (LVEF21%〜30%),QRS延長 (155〜209 ms),NYHAクラス3-4の症状を発症しました.
- CRTは,LVEF (3.0%),生活の質 (8.0ポイント),および機能的状態を改善しました (59%の改善>=1NYHAクラス).
- CRTは入院率 (37%) と全因死亡率 (22%) を減少させ,インプラントの成功率は93.0%であった.
結論:
- CRTは,LVシストリック機能不全,長期QRS,重度の心不全症状を有する患者の罹患率と死亡率を低減するのに有効です.
- CRTは,最適な薬剤治療の補助薬として考慮されるべきです.
- CRT単独のCRTと比較して, implantable cardioverter-defibrillatorsと組み合わせたCRTの利点は,さらなる調査を必要としています.
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