心脏再同步化治疗对心衰患者发病率和死亡率的影响

作     者：Cleland J. G. F. Daubert J.-C. Erdmann E. 宁宁 

作者机构：Department of Cardiology Castle Hill Hospital University of Hull Kingston-upon-Hull United Kingdom 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第10期

页      面：28-29页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：心脏再同步化 患者发病率 心脏协会 次要终点 左室收缩功能 心血管事件 射血分数 全因死亡 左心室功能 死亡风险 

摘      要：Cardiac Resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We evaluated its effects on morbidity and mortality. METHODS: Patients with New York Heart Association class IEt or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony who were receiving standard pharmacologic therapy were randomly assigned to receive medical therapy alone or with cardiac Resynchronization. The primary end point was the time to death from any cause or an unplanned hospitalization for a major cardiovascular event The principal secondary end point was death from any cause. RESULTS: A total of 813 patients were enrolled and followed for a mean of 29.4 months. The primary end point was reached by 159 patients in the cardiac-Resynchronization group, as compared with 224 patients in the medical-therapy group(39 percent vs. 55 percent; hazard ratio, 0.63; 95 percent confidence interval, 0.51 to 0.77; P 0.001). There were 82 deaths in the cardiac-Resynchronization group, as compared with 120 in the medical-therapy group(20 percent vs. 30 percent; hazard ratio 0.64; 95 percent confidence interval, 0.48 to 0.85; P 0.002). As compared with medical therapy, cardiac Resynchronization reduced the interventricular mechanical delay, the end-systolic volume index, and the area of the mitral regurgitant jet; increased the left ventricular ejection fraction; and improved symptoms and the quality of life(P 0.01 for all comparisons). CONCLUSIONS: In patients with heart failure and cardiac dyssynchrony, cardiac Resynchronization improves symptoms and the quality of life and reduces complications and the risk of death. These benefits are in addition to those afforded by standard pharmacologic therapy. The implantation of a cardiac-Resynchronization device should routinely be considered in such patients.