多点节奏与改善预后和心脏再同步治疗反应有关:MORE-CRT MPP随机研究的二次分析
Calò Leonardo1, De Ruvo Ermenegildo1, Kolb Christof2
1Division of Cardiology, Policlinico Casilino, Rome, Italy.
概括
多点节拍 (MPP) 为心力衰竭患者提供了改善的结果,这些患者对标准双心脏节拍 (BIV) 没有反应. 这种先进的CRT方法减少了住院治疗,并促进了左心室逆向重塑.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 心脏衰竭管理的管理
背景情况:
- 心脏再同步疗法 (CRT) 与双心室 (BIV) 节奏是心力衰竭 (HF) 患者的标准,心力衰竭患者的减少射出分数和延长的QRS.
- 四极导线可实现多点节奏 (MPP),允许刺激多个左心室 (LV) 部位.
研究的目的:
- 评估MPP在那些不响应标准BIV节奏的患者中的临床益处.
主要方法:
- 一项随机试验,将MPP与CRT无响应患者的标准BIV节奏进行比较.
- 患者在随机化之前有97%以上的BIV节奏,并对临床和心声学数据进行了12个月的跟踪.
- 主要终点:无心脏死亡,HF住院,LV末缩体积 (LVESV) 减少≥15%.
主要成果:
- 与BIV相比,MPP的初级终点率较高 (33.0%与23.5%,P=0.0103).
- 在MPP组中,HF住院病例明显较低 (4.81%对9.60%,P=0.0245).
- 在具有显著的腹腔间延迟 (>30毫秒) 的小组中,反向重塑更频繁地与MPP (35.3%与17.7%,P=0.0335).
结论:
- 对于CRT无反应患者来说,MPP是一种有益的替代方案,可以改善临床结果.
- 与标准的BIV节奏相比,MPP减少了HF住院和增加了逆LV改造的可能性.
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