预防性ICD生存益处预测:主要得分的审查和比较
Moshe Rav-Acha1,2, Ziv Dadon1,2, Arik Wolak1,2
1Jesselson Integrated Heart Center Share Zedek Medical Center, Jerusalem 9103102, Israel.
Journal of clinical medicine
|September 14, 2024
概括
风险评分有助于识别心力衰竭患者,这些患者最受益于可植入式心脏转换器-除器 (ICD). 一些得分显示低风险群体的生存益处,但不是高风险群体,有助于临床决策.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 预测分析是一种预测分析.
背景情况:
- 目前的指导方针建议预防性植入式心脏转换器-除器 (ICD) 用于症状性心力衰竭 (HF) 低射出率 (EF) 患者.
- 然而,许多患者没有从ICD中受益,有些人经历了与设备相关的并发症,需要更好的风险分层.
- 评分系统对于识别具有差异性ICD生存益处的子组至关重要,以最大限度地提高疗效并最大限度地减少伤害.
研究的目的:
- 审查和评估现有的评分系统,以预测心力衰竭患者预防性ICD的生存益处.
- 评估心脏MRI (CMR) 和基因分析在预测心室心律不整 (VAs) 中的有用性.
- 确定当前的分数是否可以指导ICD植入的临床决策.
主要方法:
- 审查已建立的风险评分,如基于MADIT试验的风险分层评分 (MRSS) 和西雅图心力衰竭模型 (SHFM).
- 分析使用心脏MRI (CMR) 预测心室心律不整 (VAs) 的研究.
- 检查基因分析对心律失常风险的预测价值的数据.
主要成果:
- 大多数评分系统主要预测死亡率,而不是持续腹腔失常 (VA) 发生率.
- 多个评分有效地识别高风险子组,在ICD植入后的高早期死亡率.
- 低风险和中等风险的小组显示了MRSS和SHFM的实际ICD生存益处,而高风险的小组 (16-20%) 显示没有益处.
- CMR可靠地确定了与VA相关的心肌痕和"通道".
- 在基因分析中,在一小部分患者中发现了突变,预测了心律失常风险的增加.
结论:
- 当前的评分模型可以划分具有不同预防性ICD益处的患者子组,但缺乏足够的可预测性来实施指南.
- 这些评分可以帮助临界病例,特别是老年患者或患有并发症的患者.
- 心脏MRI显示在识别VA风险超出单独喷射小部分的承诺.
- 遗传分析可能进一步完善心律失常事件的风险分层.
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