Becker Michael, Erdmann Nora, Stegemann Emilia, Benke Dirk, Schauerte Patrick N, Schaefer Wolfgang M, Autschbach Ruediger, Kelm Malte, Koch Karl-Christian
Department of Cardiology, RWTH Aachen University, Germany.
J Heart Lung Transplant. 2008 Jul;27(7):746-52. doi: 10.1016/j.healun.2008.03.024. Epub 2008 May 19.
Current treatment of advanced chronic heart failure comprises pharmacologic approaches, multidisciplinary management strategies and device therapy. We sought to compare the outcome after cardiac synchronization therapy (CRT) with the outcome after heart transplantation within a contemporary heart failure management program.
In a cohort study, survival and quality of life were assessed in 105 patients who had received CRT (53% with defibrillator) for severe heart failure and in 112 heart transplant recipients attending a heart failure clinic at a tertiary hospital. For assessment of health-related quality of life the Medical Outcome Short Form 36 (SF-36) was applied to the survivors. A propensity score for receiving transplantation vs CRT was developed using logistic regression and was incorporated into statistical models.
Severity of heart failure before heart transplantation or CRT was similar. Survival was not different between device recipients and transplant recipients by Kaplan-Meier analysis. Cox regression analysis with time-dependent covariates revealed a significant interaction between treatment and time, which favored transplantation late after intervention. There were no significant differences in 7 of 8 subjective measures of health-related quality of life. The score for physical functioning was higher in the transplantation group; this difference remained of borderline significance after multivariate adjustment.
Contemporary management of patients with advanced heart failure including CRT leads to improved survival and quality of life and diminishes the difference in these outcomes between conservative management and heart transplantation within the time-frame studied. Patient selection for heart transplantation requires consideration of these results.
目前晚期慢性心力衰竭的治疗包括药物治疗、多学科管理策略和器械治疗。我们试图在当代心力衰竭管理项目中比较心脏再同步治疗（CRT）与心脏移植后的结局。
在一项队列研究中，对105例因严重心力衰竭接受CRT治疗（53%植入除颤器）的患者和112例在一家三级医院心力衰竭门诊就诊的心脏移植受者的生存情况和生活质量进行了评估。对幸存者应用医学结局简明健康调查量表（SF-36）评估与健康相关的生活质量。使用逻辑回归建立接受移植与CRT的倾向评分，并将其纳入统计模型。
心脏移植或CRT前心力衰竭的严重程度相似。通过Kaplan-Meier分析，器械植入受者和移植受者的生存率没有差异。采用时间依赖性协变量的Cox回归分析显示治疗与时间之间存在显著交互作用，这有利于干预后期进行移植。在8项与健康相关的生活质量主观测量指标中的7项上没有显著差异。移植组的身体功能评分较高；多变量调整后，这种差异仍具有临界显著性。
包括CRT在内的当代晚期心力衰竭患者管理可提高生存率和生活质量，并在研究的时间范围内缩小保守治疗与心脏移植在这些结局上的差异。心脏移植的患者选择需要考虑这些结果。
