Fauchier Laurent, Poret Philippe, Robin Isabelle, de Labriolle Axel, Giraudeau Cedric, Cosnay Pierre, Babuty Dominique
Cardiologie B, Centre Hospitalier Universitaire Trousseau, Tours, France.
Am J Cardiol. 2006 Feb 1;97(3):393-9. doi: 10.1016/j.amjcard.2005.08.059.
There are still controversies about pertinent criteria for cardiac resynchronization therapy (CRT) and prophylactic indications for biventricular cardioverter-defibrillators, particularly in idiopathic dilated cardiomyopathy (IDC). This study compared several criteria for resynchronization therapy in IDC among those of several completed trials. In 201 patients with IDC, the relative risk for (1) death from heart failure (HF) or heart transplantation and (2) sudden death or sustained ventricular tachyarrhythmia were calculated separately according to the inclusion criteria of the Multisite Stimulation in Cardiomyopathy (MUSTIC), InSync, Multicenter InSync Randomized Clinical Evaluation (MIRACLE), Pacing Therapies for Congestive Heart Failure (PATH-CHF), Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION), and CONTAK studies. The percentage of patients meeting the criteria ranged from 6% for those of MUSTIC to 23% for those of CONTAK. In a follow-up of 51 +/- 42 months, 28 patients died (15 from progressive HF, 13 from sudden death), 20 underwent heart transplantation, and 12 had sustained ventricular tachyarrhythmia. Relative risks of worsening HF ranged from 3.14 (95% confidence interval [CI] 1.41 to 6.99, p = 0.005) for the MIRACLE criteria to 4.63 (95% CI 1.76 to 12.2, p = 0.0019) for the MUSTIC criteria. Only the CONTAK criteria were significantly associated with a risk for major arrhythmic events (2.65, 95% CI 1.19 to 5.95, p = 0.018). Arrhythmic events constituted 16% of all cardiac events for the MUSTIC patients, 11% for InSync patients, 31% for PATH-CHF patients, 36% for MIRACLE patients, 38% for COMPANION patients, and 42% for CONTAK patients. In conclusion, in IDC, the less restrictive criteria for CRT were associated with the greatest risk for arrhythmic events. In contrast, patients with the MUSTIC criteria for CRT mainly had a risk for worsening HF and may not benefit from biventricular cardioverter-defibrillators.
关于心脏再同步治疗（CRT）的相关标准以及双心室心脏复律除颤器的预防性适应症仍存在争议，尤其是在特发性扩张型心肌病（IDC）中。本研究比较了几项已完成试验中IDC患者再同步治疗的几种标准。在201例IDC患者中，分别根据心肌病多部位刺激（MUSTIC）、InSync、多中心InSync随机临床评估（MIRACLE）、充血性心力衰竭起搏治疗（PATH-CHF）、心力衰竭药物治疗、起搏和除颤比较（COMPANION）以及CONTAK研究的纳入标准，计算了（1）因心力衰竭（HF）死亡或心脏移植以及（2）猝死或持续性室性心律失常的相对风险。符合标准的患者百分比范围从MUSTIC标准的6%到CONTAK标准的23%。在51±42个月的随访中，28例患者死亡（15例死于进行性HF，13例死于猝死），20例接受了心脏移植，12例发生了持续性室性心律失常。HF恶化的相对风险范围从MIRACLE标准的3.14（95%置信区间[CI]1.41至6.99，p = 0.005）到MUSTIC标准的4.63（95%CI 1.76至12.2，p = 0.0019）。只有CONTAK标准与主要心律失常事件风险显著相关（2.65，95%CI 1.19至5.95，p = 0.018）。心律失常事件在MUSTIC患者的所有心脏事件中占16%，InSync患者中占11%，PATH-CHF患者中占31%，MIRACLE患者中占36%，COMPANION患者中占38%，CONTAK患者中占42%。总之，在IDC中，CRT限制较少的标准与心律失常事件的最大风险相关。相比之下，符合CRT的MUSTIC标准的患者主要有HF恶化的风险，可能无法从双心室心脏复律除颤器中获益。
