Zardkoohi Omeed, Nandigam Veena, Murray Lorne, Heist E Kevin, Mela Theofanie, Orencole Mary, Ruskin Jeremy N, Singh Jagmeet P
Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Pacing Clin Electrophysiol. 2007 Nov;30(11):1344-8. doi: 10.1111/j.1540-8159.2007.00869.x.
Cardiac resynchronization therapy (CRT) outcome varies significantly among patients. We aimed to determine the impact of age, gender, and heart failure etiology on the long-term outcome of patients receiving CRT.
A total of 117 patients with drug-refractory heart failure, New York Heart Association (NYHA) Class III or IV, and a wide QRS complex, who received CRT, were followed for one year. Long-term outcome was measured as a combined end point of hospitalization for heart failure and/or all cause mortality. Efficacy of CRT was compared between men and women, between older and younger patients, and between patients with ischemic and nonischemic heart disease. Time to the primary end point was estimated by the Kaplan-Meier method and comparisons were made using the Breslow-Wilcoxon test.
Baseline clinical characteristics were comparable between gender, age, and heart failure etiology subgroups. There was no significant difference in the combined end point between older versus younger (age >70, (n = 71), versus age < 70, (n = 46), P = 0.52); both genders (men, n = 91 vs women, n = 26, P = 0.46) and etiology of the cardiomyopathy (ischemic (n = 79) vs nonischemic (n = 38), P = 0.12). Substratification of the genders by the etiology of the cardiomyopathy, showed that women with ischemic cardiomyopathy (IW, n = 10) had a trend to a worse outcome compared to the other groups i.e., nonischemic women (NIW, n = 16), ischemic men (IM, n = 69), and nonischemic men (NIM, n = 22), P = 0.04. After adjusting for potential covariates, a Cox regression analysis showed no significant difference between the groups (P = 0.61).
CRT outcome appears independent of age, gender, and heart failure etiology in this single institution study.
心脏再同步治疗（CRT）在患者中的疗效差异显著。我们旨在确定年龄、性别和心力衰竭病因对接受CRT治疗患者长期疗效的影响。
对117例药物难治性心力衰竭、纽约心脏协会（NYHA）心功能Ⅲ级或Ⅳ级且QRS波增宽并接受CRT治疗的患者进行了为期一年的随访。长期疗效以心力衰竭住院和/或全因死亡率的综合终点来衡量。比较了男性与女性、老年患者与年轻患者以及缺血性和非缺血性心脏病患者之间CRT的疗效。采用Kaplan-Meier法估计至主要终点的时间，并使用Breslow-Wilcoxon检验进行比较。
性别、年龄和心力衰竭病因亚组之间的基线临床特征具有可比性。年龄较大与较小者（年龄>70岁，（n = 71），与年龄<70岁，（n = 46），P = 0.52）；男女两性（男性，n = 91 vs女性，n = 26，P = 0.46）以及心肌病病因（缺血性（n = 79）vs非缺血性（n = 38），P = 0.12）在综合终点方面均无显著差异。按心肌病病因对性别进行亚分层显示，缺血性心肌病女性（IW，n = 10）与其他组相比有预后较差的趋势，即非缺血性女性（NIW，n = 16）、缺血性男性（IM，n = 69）和非缺血性男性（NIM，n = 22），P = 0.04。在对潜在协变量进行校正后，Cox回归分析显示各组之间无显著差异（P = 0.61）。
在这项单机构研究中，CRT疗效似乎与年龄、性别和心力衰竭病因无关。
