在心力衰竭中升级右心室节奏到心脏再同步治疗:一个随机试验
Béla Merkely1, Robert Hatala2, Jerzy K Wranicz3
1Heart and Vascular Center, Semmelweis University, Varosmajor 68, H-1122 Budapest, Hungary.
European heart journal
|August 26, 2023
概括
升级为心脏再同步治疗与除器 (CRT-D) 显著降低死亡率和心力衰竭住院治疗的患者减少喷射率和高右心室节奏负担. 这种CRT-D升级比标准的植入式心脏转换器-除器疗法提供了相当大的好处.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏衰竭管理的管理
背景情况:
- 用除器 (CRT-D) 进行心脏再同步治疗,有效治疗心力衰竭,减少排气分数 (HFrEF) 和左捆分支阻塞.
- 在HFrEF患者中升级到CRT-D的好处与显著的右心室节奏 (RVP) 负担尚未得到充分确立.
研究的目的:
- 评估升级到CRT-D与标准植入式心脏转换器-除器 (ICD) 治疗在高RVP负担的HFrEF患者中的疗效.
主要方法:
- 一个多中心,随机对照试验,涉及360名有症状的HFrEF患者,具有高RVP负担 (≥20%) 和广泛的QRS持续时间 (≥150毫秒).
- 患者被随机分配为3:2接受CRT-D升级 (n=215) 或单独接受ICD (n=145).
- 主要结局是所有原因死亡率,心力衰竭住院治疗或12个月后左心室末缩体积减少<15%的综合结果.
主要成果:
- 主要结局在CRT-D组 (32.4%) 与ICD组 (78.9%) 相比发生频率明显低 (OR 0.11,P < .001).
- 在CRT-D组 (10%) 与ICD组 (32%) (HR 0.27,P <.001) 中,全因死亡率或心力衰竭住院病例也明显较低.
- 在两组中,与手术或器械相关的并发症发生率相似.
结论:
- 在具有显著RVP负担和广泛QRS持续时间的HFrEF患者中升级到CRT-D优于单独的ICD治疗.
- CRT-D升级有效降低了死亡率,心力衰竭住院和缺乏逆转改造的综合风险.
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