心脏收缩力调制对心力衰竭患者长期生存的改善：一项病例对照研究。
Improvement of long-term survival by cardiac contractility modulation in heart failure patients: A case-control study.
作者信息
Liu Ming, Fang Fang, Luo Xiu Xia, Shlomo Ben-Haim, Burkhoff Daniel, Chan Joseph Y S, Chan Chin-Pang, Cheung Lili, Rousso Benny, Gutterman David, Yu Cheuk-Man
机构信息
Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong.
Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong.
出版信息
Int J Cardiol. 2016 Mar 1;206:122-6. doi: 10.1016/j.ijcard.2016.01.071. Epub 2016 Jan 6.
INTRODUCTION
Cardiac contractility modulation (CCM) has been shown to be effective in improving symptoms and cardiac function in heart failure (HF). However, there is limited data on the role of CCM on long-term survival, which was explored in the present study.
METHODOLOGY
Forty-one consecutive HF patients with left ventricular ejection fraction (EF) <40% received CCM and were followed for approximately 6 years. They were compared with another 41 HF patients who were enrolled into the HF registry in the same period, and had similar age, gender, EF and etiology of HF. The primary end-point was all cause-mortality. This was stratified by EF. Secondary end-points included HF hospitalization, cardiovascular death, and the composite outcome of death or heart failure hospitalization.
RESULTS
The CCM and control groups were well balanced for demographic data, medications and baseline left ventricular EF (27 ± 6 vs 27 ± 7%, p=NS). The mean follow-up duration was 75 ± 19 months in the CCM group and 69 ± 17 months in the control group. All-cause mortality was lower in the CCM group than the control group (39% vs. 71%, respectively; Log-rank χ(2)=11.23, p=0.001). Of note, the improvement of all-cause mortality is more dramatic in patients with EF ≥ 25-40% (36% vs. 80%, Log-rank χ(2)=15.8, p<0.001) than those with EF<25% (50% vs. 56%, p=NS), CCM vs. control respectively. Similar results were shown for the benefit of CCM in the secondary endpoints of cardiovascular death, and the composite outcome of death or heart failure hospitalization. The occurrence of HF hospitalization showed no significant difference between CCM and control groups in the whole cohort (41% vs. 49%, p=NS), but was significantly lower with CCM in subjects with EF ≥ 25-40% at baseline (36% vs. 64%, Log-rank χ(2)=7.79, p=0.005).
CONCLUSION
CCM resulted in significant improvement of long-term survival, in particular in those with EF ≥ 25-40%. A reduction in heart failure hospitalizations was also seen in this group of patients with less severely reduced EF.
引言
心脏收缩力调制（CCM）已被证明可有效改善心力衰竭（HF）患者的症状和心脏功能。然而，关于CCM对长期生存作用的数据有限，本研究对此进行了探讨。
方法
41例连续入选的左心室射血分数（EF）<40%的HF患者接受CCM治疗，并随访约6年。将他们与同期纳入HF登记处的另外41例HF患者进行比较，这些患者在年龄、性别、EF和HF病因方面相似。主要终点是全因死亡率。按EF进行分层。次要终点包括HF住院、心血管死亡以及死亡或HF住院的复合结局。
结果
CCM组和对照组在人口统计学数据、用药情况和基线左心室EF方面（分别为27±6%对27±7%，p=无显著性差异）具有良好的平衡性。CCM组的平均随访时间为75±19个月，对照组为69±17个月。CCM组的全因死亡率低于对照组（分别为39%对71%；对数秩χ(2)=11.23，p=0.001）。值得注意的是，EF≥25 - 40%的患者全因死亡率的改善比EF<25%的患者更显著（分别为36%对80%，对数秩χ(2)=15.8，p<0.001），CCM组对对照组。在心血管死亡的次要终点以及死亡或HF住院的复合结局方面，CCM的益处也有类似结果。在整个队列中，CCM组和对照组的HF住院发生率无显著差异（分别为41%对49%，p=无显著性差异），但在基线时EF≥25 - 40%的受试者中，CCM组的HF住院发生率显著更低（分别为36%对64%，对数秩χ(2)=7.79，p=0.005）。
结论
CCM可显著改善长期生存，尤其是EF≥25 - 40%的患者。在这组EF降低程度较轻的患者中，HF住院率也有所降低。
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