左心室逆转型改造但没有临床改善预测心脏再同步治疗后的长期存活率
Cheuk-Man Yu1, Gabe B Bleeker, Jeffrey Wing-Hong Fung
1Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. cmyu@cuhk.edu.hk
Circulation
|September 8, 2005
概括
在心脏再同步治疗 (CRT) 后,左心室末缩体积 (LVESV) 减少10%表明显著的反向重塑. 这种改善预测了严重心力衰竭患者的更好的长期存活率和更少的心力衰竭事件.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭管理的管理
- 医疗干预 医疗干预
背景情况:
- 心脏再同步治疗 (CRT) 改善左心室 (LV) 功能和严重心力衰竭的存活率.
- 在CRT后LV逆转型重塑的长期预后意义及其临床相关程度仍然不清楚.
研究的目的:
- 为了确定CRT后LV逆转改造是否预测长期预后.
- 确定LV逆转型重塑的特定程度,对患者的治疗结果具有临床意义.
主要方法:
- 接受CRT的141名晚期心力衰竭患者被随访了平均695天.
- 在3-6个月内,使用接收器操作特征 (ROC) 曲线分析左心室末缩体积 (LVESV) 减少,以找到死亡率预测截止值.
- 卡普兰-梅尔生存和考克斯回归分析比较了响应者和不响应者之间的结果.
主要成果:
- 确定LVESV降低≥9.5%是预测死亡率的最佳切线 (70%敏感度,70%所有原因的特异性;87%敏感度,69%心血管特异性).
- 61.7%的患者被归类为反向改造的响应者.
- 与非响应者相比,受试者显示所有原因死亡率 (6.9%vs30.6%),心血管死亡率 (2.3%vs24.1%) 和心力衰竭事件 (11.5%vs33.3%) 显著降低.
- LVESV变化是死亡率最强的预测因素,超过了临床参数.
结论:
- 在LVESV≥10%的减少表明临床相关的逆转型改造后CRT.
- 这种逆转型的程度是减少长期死亡率和心力衰竭事件的强有力的预测因素.
- 评估干预后体积变化为心力衰竭患者提供了有价值的预后信息.
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