Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
Europace. 2012 Nov;14(11):1602-7. doi: 10.1093/europace/eus168.
To compare the improvement of quality of life (QoL) in cardiac resynchronization therapy plus implantable cardioverter defibrillator (CRT-D) therapy with that in implantable cardioverter defibrillator (ICD) therapy alone for patients with heart failure.
Medline, Embase, The Cochrane Library, and US Food and Drug Administration website were searched for published studies up to 31 December 2011. Studies were considered for inclusion if they were randomized controlled trials (RCTs) that compared the efficacy of CRT-D therapy with ICD therapy in patients with heart failure. The primary outcome of this study was improvement in QoL. Four RCTs with 1655 patients were included in this meta-analysis. Overall, the QoL score of patients in CRT-D group significantly improved [weighted mean difference (WMD): -6.02; 95% confidence interval (CI): -10.56 to -1.48] compared with that in the ICD only group. However, the benefit with respect to QoL in CRT-D group was not maintained when subset meta-analysis was performed in patients with New York Heart Association (NYHA) class I-II (WMD: 0.19; 95% CI: -3.89 to 4.72), whereas the patients with NYHA class III-IV in CRT-D group still experienced a significant improvement of QoL score compared with ICD group (WMD: -8.49; 95% CI: -13.39 to -3.59).
CRT-D therapy improves the QoL compared with ICD therapy alone, especially in patients with moderate to severe heart failure.
比较心脏再同步治疗加植入式心脏复律除颤器（CRT-D）治疗与单纯植入式心脏复律除颤器（ICD）治疗对心力衰竭患者生活质量（QoL）的改善作用。
检索 Medline、Embase、The Cochrane Library 和美国食品和药物管理局网站，截至 2011 年 12 月 31 日，查找发表的相关研究。纳入标准为：随机对照试验（RCT），比较 CRT-D 治疗与 ICD 治疗心力衰竭患者的疗效。本研究的主要结局为 QoL 的改善。共有 4 项 RCT（1655 例患者）符合纳入标准。荟萃分析结果显示，CRT-D 组患者的 QoL 评分明显高于 ICD 组[加权均数差（WMD）：-6.02；95%置信区间（CI）：-10.56 至-1.48]。但当亚组分析仅纳入 NYHA 心功能分级 I-II 级患者时，CRT-D 组在 QoL 方面的优势并不显著[WMD：0.19；95%CI：-3.89 至 4.72]，而 CRT-D 组 NYHA 心功能分级 III-IV 级患者的 QoL 评分仍明显高于 ICD 组[WMD：-8.49；95%CI：-13.39 至-3.59]。
与单纯 ICD 治疗相比，CRT-D 治疗可改善心力衰竭患者的 QoL，尤其是在中重度心力衰竭患者中。
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