不有效的心脏重同步节奏与全国性队列分析中的糟糕结果有关
Shelief Y Robbins-Juarez1, Suneet Mittal2, Chris Plummer3
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
Heart rhythm
|July 19, 2024
概括
不有效的心脏再同步治疗 (CRT) 节奏显著降低了患者的生存率. 尽量减少无效的心室节奏 (VP) 对于改善CRT患者的结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 生物医学工程 生物医学工程
- 临床电生理学 临床电生理学
背景情况:
- 心脏再同步治疗 (CRT) 需要有效的左心室捕获以获得临床益处.
- 不有效的心室节奏 (VP) 对患者存活率的影响仍然是一个重要的临床问题.
- 优化CRT输送对于最大限度地提高治疗疗效至关重要.
研究的目的:
- 调查无效腹腔节奏 (VP) 和患者存活率之间的关联.
- 量化不同程度的无效VP对长期结果的影响.
- 确定影响生存的无效VP的值.
主要方法:
- 分析了7987名患者的非识别电子健康记录和设备数据.
- 无效VP的定义是交付和有效CRT节奏之间的差异.
- 利用卡普兰-梅尔和考克斯的比例危险模型来评估生存率.
- 随访持续时间平均为2.1年.
主要成果:
- 不有效的VP的增加与生存率的降低有显著关联.
- >1.47%无效VP的患者的3年生存率较低 (75.7%),而<0.08% (85.1%) 的患者则较低.
- 低于最佳的CRT节奏 (<97.7%VP) 和>2%的无效VP独立预测了减少的生存率 (aHR分别为1.29和1.35).
结论:
- 不有效的心室节奏是CRT患者生存率下降的重要独立预测因素.
- 尽量减少无效VP的策略至关重要,同时最大限度地提高整体CRT节奏百分比.
- 临床努力应集中在优化位和设备编程上,以减少无效的节奏.
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