心臓再同期療法は,中等から重度の機能性ミトラル吐および高手術リスクを有する患者の治療選択肢として用いられる
Rutger J van Bommel1, Nina Ajmone Marsan, Victoria Delgado
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Circulation
|August 4, 2011
まとめ
心臓再同期療法 (CRT) は,高リスクの心不全患者における機能的ミトラル吐 (MR) を改善することができます. CRT後のMRの有意な改善は,より高い生存率と関連しています.
科学分野:
- 心臓病学 心臓病学
- 心不全管理について
- 医療機器 医療機器について
背景:
- 機能性ミトラル反発 (MR) は,拡張性心筋症候群の心不全において一般的であり,予後に影響を及ぼします.
- 高い手術リスクは,これらの患者の治療選択肢を制限します.
- 心臓再同期療法 (CRT) は,MRの改善に有望であることが示されています.
研究 の 目的:
- 高リスクの心不全患者の機能性MRの治療としてCRTを評価する.
- CRT後のMR改善が患者の生存に影響するかどうかを判断する.
主な方法:
- 中等から重度の機能性MRを有する高リスク患者98人がCRTを受けた.
- エコーカルディオグラフィーは,基値と6ヶ月でMRの重症度を評価した.
- 生存率は,平均32ヶ月で分析されました.
主要な成果:
- 49%の患者がCRT後にMRの有意な改善 (グレード≥1) を示した.
- MR改善を受けた患者は,改善しない患者と比較して生存率が優れていた (P<0.001).
- MRの改善は生存の独立した予測因子であった (HR 0.35,P=0.043).
結論:
- CRTは,機能的なMRと手術のリスクが高い心不全の患者にとって有効な選択肢です.
- CRT後のミトラル反吐の改善は,長期的な生存率の向上と関連しています.
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