Thorax Clinic Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Villarroel 170, Barcelona 08036, Spain.
Europace. 2010 Aug;12(8):1136-40. doi: 10.1093/europace/euq163. Epub 2010 Jun 12.
Although the benefit of cardiac resynchronization therapy (CRT) in selected patients with heart failure is well established, its effect on mortality in New York Heart Association (NYHA) class IV patients remains unclear. Our study evaluated the effect of CRT on urgent transplant-free survival in NYHA class IV patients treated with CRT, compared with medication-only treatment.
Forty NYHA class IV patients treated with CRT (80% men, 62.5% ischaemic, mean age of 65) were matched 1:1 by age, gender and aetiology of cardiomyopathy with patients treated with optimal medical therapy (OPT group). No significant differences were found between the groups in left ventricular diastolic diameter (71 +/- 6 vs. 73 +/- 9 mm), left ventricular systolic diameter (58 +/- 7 vs. 61 +/- 11 mm), and left ventricular ejection fraction (23 +/- 5 vs. 22 +/- 6%). Mean follow-up was 13.2 +/- 9.5 months for the CRT group and 17.3 +/- 11.6 months for the OPT group. Time to all-cause death or urgent transplantation [hazard ratios (HR), 1.29; 95% CI: 0.59-2.83; P = 0.52] or to cardiovascular death or urgent transplantation (HR, 1.53; 95% CI: 0.64-3.67; P = 0.34) was not reduced significantly in patients treated with CRT.
In this study, CRT did not significantly improve survival of NYHA class IV heart failure patients compared with pharmacological therapy.
尽管心脏再同步治疗（CRT）已被证实可使特定心力衰竭患者获益，但 CRT 对纽约心脏协会（NYHA）IV 级患者死亡率的影响尚不清楚。本研究评估了 CRT 对 NYHA IV 级心力衰竭患者（接受 CRT 治疗）与单纯药物治疗相比，在无紧急移植生存方面的影响。
40 名接受 CRT 治疗的 NYHA IV 级患者（80%为男性，62.5%为缺血性，平均年龄 65 岁）按年龄、性别和心肌病病因与接受最佳药物治疗（OPT 组）的患者进行 1:1 匹配。两组间左心室舒张末期直径（71±6 与 73±9mm）、左心室收缩末期直径（58±7 与 61±11mm）和左心室射血分数（23±5 与 22±6%）无显著差异。CRT 组的平均随访时间为 13.2±9.5 个月，OPT 组为 17.3±11.6 个月。全因死亡或紧急移植的时间[风险比（HR），1.29；95%置信区间：0.59-2.83；P=0.52]或心血管死亡或紧急移植的时间（HR，1.53；95%置信区间：0.64-3.67；P=0.34）在接受 CRT 治疗的患者中并未显著降低。
在这项研究中，与药物治疗相比，CRT 并未显著改善 NYHA IV 级心力衰竭患者的生存率。
