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在心脏再同步治疗后立即强化药物治疗:发生率,特征和影响

Kojiro Ogawa¹, Hiro Yamasaki¹, Kazutaka Aonuma¹

¹Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.

ESC heart failure

|March 11, 2024

概括

在心脏再同步治疗后立即加强心力衰竭药物治疗可以改善患者的结果. 这一策略在符合条件的患者中显著降低了心力衰竭的死亡率和住院.

科学领域:

心脏病学心脏病学
医疗器械医疗器械
药理学药理学是指药理学的学科.

背景情况:

心脏再同步疗法 (CRT) 是治疗药物耐药性心力衰竭 (HF) 的关键治疗方法,用于患有左捆支部阻塞 (LBBB) 的患者.
在CRT后的急性血液动力学改善可能允许加快HF药物的强化.
立即强化药物治疗 (IPI) 可以提供协同效益并改善预后.

研究的目的:

调查在CRT接受者之前急性HF住院治疗的IPI的发病率和特征.
评估IPI对该患者群体临床结果的现实影响.

主要方法:

一项多中心的回顾性研究,对194名CRT接受者进行了LBBB,QRS宽度≥120 ms,LVEF≤35%,NYHAII-IV症状,所有人都最近住院治疗过HF.
IPI定义为指导方针导向的医学治疗 (β-阻断剂,ACE抑制剂/ARBs,MRAs) 在CRT后30天内加强.
主要终点:全因死亡或HF住院;次要终点:全因死亡. 随访时间中位数:29个月.

主要成果:

54%的患者接受了IPI. IPI患者的QRS持续时间更短,EGFR更高,心肌病扩张更大.
IPI与初级和二级终点的显著更好的结果有关.
IPI是减少初级终点的独立预测指标 (HR 0.51;95% CI 0.27-0.97;P=0.043).

结论:

在超过一半的CRT接受者中,立即强化药物治疗是可行的,特别是那些没有过度QRS延长,功能保留和扩大心肌病的人.
接受CRT的LBBB患者的IPI与明显更好的预后和减少HF住院病例有关.

关键词:

心脏再同步治疗心脏再同步治疗心脏衰竭是因为心脏衰竭.立即强化药物治疗的药物治疗.左捆的分支区块的分支区块.预测预后预测预测

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