Friedrich-Ebert Hospital, Medical Clinic, Friesenstr. 11, 24531 Neumünster, Germany.
Clin Res Cardiol. 2013 Jul;102(7):505-11. doi: 10.1007/s00392-013-0558-1. Epub 2013 Mar 31.
The aim of the analysis was to compare the outcome of heart failure patients in New York Heart Association (NYHA) class IV to that of NYHA class III patients 1 year after implantation of a CRT device.
The analysis was based on the 405 CRT patients enrolled in the MASCOT trial. At enrollment, 350 patients (86%) were in NYHA class III and 55 (14 %) were in NYHA class IV.
At 1-year follow-up, the improvement of the ejection fraction was not statistically significantly different between NYHA class III (+7.6 ± 11.7%) and NYHA class IV patients (+9.2 ± 14.2 %; p = 0.78). NYHA class IV patients had a better mean NYHA class reduction with -1.93 ± 0.83 than NYHA class III patients with -0.93 ± 0.70 (p < 0.0001). There was a greater mean quality of life improvement in NYHA class IV (-27.2 ± 20.9) compared to NYHA class III (-17.7 ± 23.9; p = 0.02). All-cause mortality as well as cardiac mortality remained higher in NYHA class IV with 25.5 and 16.4% than in NYHA class III with 7.1 and 3.1% (p < 0.0001).
In this study, 14% of all patients receiving a CRT device had NYHA class IV at implantation. The data support the concept to implant a CRT device in NYHA class IV patients, because at 1 year after implantation, they experienced better symptomatic improvement compared to NYHA class III patients. The higher cardiac as well as non-cardiac mortality resulted in a fivefold higher all-cause mortality compared to NYHA class III patients.
本分析旨在比较纽约心脏协会（NYHA）心功能分级 IV 级与 III 级心力衰竭患者在 CRT 设备植入后 1 年的结局。
该分析基于 MASCOT 试验中纳入的 405 例 CRT 患者。入组时，350 例（86%）患者为 NYHA 心功能分级 III 级，55 例（14%）为 NYHA 心功能分级 IV 级。
在 1 年随访时，NYHA 心功能分级 III 级患者（+7.6±11.7%）与 NYHA 心功能分级 IV 级患者（+9.2±14.2%；p=0.78）的射血分数改善无统计学显著差异。NYHA 心功能分级 IV 级患者的平均 NYHA 心功能分级改善较 NYHA 心功能分级 III 级患者更显著，分别为-1.93±0.83 与-0.93±0.70（p<0.0001）。NYHA 心功能分级 IV 级患者的生活质量改善更明显（-27.2±20.9），而 NYHA 心功能分级 III 级患者为-17.7±23.9（p=0.02）。全因死亡率和心源性死亡率在 NYHA 心功能分级 IV 级患者中分别为 25.5%和 16.4%，高于 NYHA 心功能分级 III 级患者的 7.1%和 3.1%（p<0.0001）。
在这项研究中，接受 CRT 设备植入的所有患者中有 14%为 NYHA 心功能分级 IV 级。数据支持在 NYHA 心功能分级 IV 级患者中植入 CRT 设备的理念，因为在植入后 1 年，他们的症状改善优于 NYHA 心功能分级 III 级患者。更高的心源性和非心源性死亡率导致全因死亡率较 NYHA 心功能分级 III 级患者高 5 倍。
