左心室缩功能障碍患者的心脏再同步治疗:系统性审查
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
概括
心脏再同步疗法 (CRT) 显著降低左心室静脉功能障碍和心力衰竭症状的患者的发病率和死亡率. 这种治疗改善了心脏功能,生活质量和生存率,当与最佳药物治疗相结合时.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 心脏衰竭管理的管理
背景情况:
- 左心室 (LV) 缩功能障碍是致病率和死亡率的主要原因.
- 最佳的药物治疗不能完全满足所有患者的需求.
- 心脏再同步治疗 (CRT) 在2001年获得FDA批准,用于选定的患者.
研究的目的:
- 为了评估CRT在LV系统功能障碍患者的疗效,有效性和安全性.
- 要总结目前在这个患者群体中CRT的证据基础.
主要方法:
- 在2006年11月之前,对电子数据库和手动搜索进行系统审查.
- 包括14个随机试验的疗效 (4420名患者).
- 包括106项有效性研究 (9209名患者) 和89项安全性研究 (9677名患者).
主要成果:
- 患者患有LV静脉缩功能障碍 (LVEF 21%-30%),延长的QRS (155-209毫秒),以及NYHA 3-4类症状.
- CRT改善了LVEF (3.0%),生活质量 (8.0分) 和功能状态 (59%改善>=1个NYHA类).
- CRT减少了住院治疗 (37%) 和全因死亡率 (22%);植入成功率为93.0%.
结论:
- 在患有LV静脉缩功能障碍,延长的QRS和严重心力衰竭症状的患者中,CRT有效降低发病率和死亡率.
- 应该考虑CRT作为最佳药物治疗的辅助.
- 与植入式心脏转换器-除器相结合的CRT的好处与单独的CRT需要进一步调查.
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