Aston Medical Research Institute, Aston Medical School, Aston Triangle, Birmingham, West Midlands B4 7ET, UK
Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Europace. 2016 May;18(5):732-8. doi: 10.1093/europace/euv287. Epub 2016 Jan 22.
Trials have shown that cardiac resynchronization therapy (CRT) is effective in patients with 'non-ischaemic cardiomyopathy'. Patients with post-surgical valvular cardiomyopathy (PSVCM) have been excluded from such trials. We sought to compare the clinical outcome of CRT in patients with PSVCM, idiopathic dilated cardiomyopathy (IDCM), or ischaemic cardiomyopathy (ICM).
Clinical events and response to CRT were quantified in 556 patients (PSVCM = 38; IDCM = 165; ICM = 353) over 4.52 years [median, inter-quartile range (IQR): 4.42]. Response to CRT was defined as survival for ≥1 year free of hospitalizations plus improvement by ≥1 NYHA class or ≥25% in 6-min walking distance. Cardiac resynchronization therapy was initiated at 5.86 years (median, IQR: 9.86) after aortic valve replacement (73.7%) or mitral valve replacement/repair (44.7%). Compared with PSVCM, IDCM was associated with a lower total mortality [hazards ratio, HR: 0.54 (95% confidence interval, CI 0.34-0.84)], cardiac mortality [HR: 0.43 (95% CI 0.26-0.70)], and total mortality or major adverse cardiovascular events [HR: 0.57 (95% CI 0.37-0.87)], independent of known confounders. Compared with PSVCM, ICM was associated with a similar risk of death from pump failure [HR: 0.83 (95% CI 0.50-1.37)] and IDCM was associated with a lower risk [HR: 0.46 (95% CI 0.26-0.82)]. Response to CRT was similar across the groups.
Compared with IDCM, PSVCM was associated with a worse outcome after CRT. Outcomes from PSVCM were similar to ICM. These findings indicate that PSVCM behaves very differently to IDCM after CRT.
临床试验表明心脏再同步治疗（CRT）对“非缺血性心肌病”患者有效。此类试验排除了术后瓣膜性心肌病（PSVCM）患者。我们旨在比较 PSVCM、特发性扩张型心肌病（IDCM）或缺血性心肌病（ICM）患者 CRT 的临床结局。
在 556 例患者（PSVCM = 38；IDCM = 165；ICM = 353）中，经过 4.52 年的随访[中位数，四分位距（IQR）：4.42]，量化了临床事件和 CRT 反应。CRT 反应定义为至少 1 年无住院且纽约心功能分级（NYHA）至少改善 1 级或 6 分钟步行距离至少增加 25%。主动脉瓣置换（73.7%）或二尖瓣置换/修复（44.7%）后 5.86 年（中位数，IQR：9.86）开始 CRT。与 PSVCM 相比，IDCM 总死亡率[风险比（HR）：0.54（95%置信区间，CI 0.34-0.84）]、心源性死亡率[HR：0.43（95% CI 0.26-0.70）]和总死亡率或主要不良心血管事件[HR：0.57（95% CI 0.37-0.87）]均较低，独立于已知混杂因素。与 PSVCM 相比，ICM 泵衰竭相关死亡率相似[HR：0.83（95% CI 0.50-1.37）]，IDCM 则较低[HR：0.46（95% CI 0.26-0.82）]。各组 CRT 反应相似。
与 IDCM 相比，PSVCM 患者 CRT 后结局较差。PSVCM 患者的结局与 ICM 相似。这些发现表明，PSVCM 在 CRT 后与 IDCM 表现非常不同。
