在目前用于定义对心脏再同步治疗反应的标准中,一致性很差
Brandon K Fornwalt1, William W Sprague, Patrick BeDell
1Emory University School of Medicine, Department of Radiology, Atlanta, GA 30322, USA. bkf@gatech.edu
Circulation
|April 28, 2010
概括
关于心脏再同步治疗反应标准的协议很差. 大多数研究使用不同的定义,阻碍了一致的结果和患者结果的比较.
科学领域:
- 心脏病学 心脏病学
- 医疗器械技术 医疗器械技术
- 临床试验 临床试验
背景情况:
- 定义对心脏再同步治疗 (CRT) 的积极反应存在多个标准.
- 没有先前的研究评估了这些不同的响应标准之间的一致性.
- 这项研究假设不同CRT响应标准之间缺乏一致性.
研究的目的:
- 评估心脏再同步治疗不同响应标准之间的一致性.
- 根据不同的定义来量化响应率的变化.
主要方法:
- 对"心脏再同步"和"反应"进行了文献搜索,以确定相关的文章.
- 审查了50个被引用的出版物,从26篇文章中提取了17个不同的主要响应标准.
- 在PROSPECT研究中的426名患者中,使用科恩的卡帕系数评估了15个标准的一致性.
主要成果:
- 对CRT的整体反应率在15个评估标准中差异很大,从32%到91%.
- 75%的标准之间的比较显示出差的一致性 (kappa ≤ 0.4).
- 只有4%的比较表明强烈的同意 (kappa ≥0.75),21%的中度同意.
结论:
- 心脏再同步治疗的反应是根据最常引用的文献中的17个不同的标准来定义的.
- 在这些标准中,缺乏一致性 (75%) 和有限的强烈一致性 (4%) 阻碍了研究结果的概括性.
- 在响应标准上缺乏共识,这使得跨研究的CRT结果的解释和比较变得复杂.
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