Department of Cardiology, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200001, China.
Int J Cardiol. 2012 Jun 28;158(1):39-45. doi: 10.1016/j.ijcard.2010.12.091. Epub 2011 Jan 22.
Few studies have directly compared cardiac resynchronisation therapy (CRT) with combined CRT-cardioverter defibrillator therapy (CRT-D) in patients with left ventricular (LV) impairment. We performed a systematic analysis to assess the therapeutic effects of CRT and CRT-D in patients with LV impairment and heart failure.
The Medline database from 1970 to September 2010 was searched. The major outcome examined was the all-cause death rate.
A total of 3404 patients were retrieved from seven studies. Overall, CRT-D reduced all-cause death by 8.42% compared with CRT [odds ratio (OR) 0.52, 95% confidence interval (CI) 0.43-0.81, P=0.001, I(2)=63.9%]. An increased benefit was seen after extended follow-up (after 1 year, OR 0.56, CI 0.41-0.77, P=0.0004, I(2)=64.9%), but not after relatively short follow-up (within 1 year, P=0.11). Results from other endpoints examined, such as death from sudden cardiac death and heart failure, also supported CRT-D treatment.
Evidence from current randomised and non-randomised trials demonstrates some superiorities of CRT-D over CRT, such as all-cause death rate after one-year follow-up and cardiac death, in patients with LV impairment. However, these findings must be verified in larger, randomised, prospective trials, including with extended patient follow-up.
很少有研究直接比较心脏再同步治疗（CRT）与心脏再同步除颤器治疗（CRT-D）在左心室（LV）功能障碍患者中的疗效。我们进行了一项系统分析，以评估 CRT 和 CRT-D 在 LV 功能障碍和心力衰竭患者中的治疗效果。
检索了 1970 年至 2010 年 9 月的 Medline 数据库。主要观察终点是全因死亡率。
共从 7 项研究中检索到 3404 例患者。总体而言，与 CRT 相比，CRT-D 降低了 8.42%的全因死亡率[比值比（OR）0.52，95%置信区间（CI）0.43-0.81，P=0.001，I(2)=63.9%]。在延长随访（1 年后，OR 0.56，95%CI 0.41-0.77，P=0.0004，I(2)=64.9%）后观察到获益增加，但在相对短期随访（1 年内，P=0.11）后未观察到获益增加。其他终点如心源性猝死和心力衰竭死亡的结果也支持 CRT-D 治疗。
目前随机和非随机试验的证据表明，在 LV 功能障碍患者中，与 CRT 相比，CRT-D 在 1 年随访后和心脏性死亡方面具有一些优势，如全因死亡率。然而，这些发现必须在更大规模、随机、前瞻性试验中得到验证，包括对患者进行更长时间的随访。
