Szepietowska Barbara, McNitt Scott, Polonsky Bronislava, Sherazi Saadia, Biton Yitschak, Kutyifa Valentina, Aktas Mehmet K, Moss Arthur J, Zareba Wojciech
University of Rochester Medical Center, Rochester, New York, United States.
Cardiol J. 2016;23(3):344-51. doi: 10.5603/CJ.a2016.0017. Epub 2016 Apr 11.
Although association of metabolic syndrome (MS) and ischemic heart disease is strongly established, it is not known whether presence of MS may differently influence clinical responses to cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the associations between obesity and metabolic features and the clinical outcome after cardiac resynchronization with defibrillator therapy (CRT-D), compared to an implantable cardioverter defibrillator (ICD).
The risk of heart failure (HF) or death and death alone was evaluated in 829 non-obese patients, 156 obese patients without MS, and 277 obese patients with MS (all with left bundle branch block), who were enrolled in the Multicenter Automatic Defibrillator Implanta-tion Trial with Cardiac Resynchronization Therapy (MADIT-CRT).
Obese patients with MS (HR 0.50, 95% CI 0.32-0.77, p = 0.002), obese patients without MS (HR 0.57, 95% CI 0.30-1.06, p = 0.077), and non-obese patients (HR 0.48, 95% CI 0.37-0.62, p < 0.001) had a similar risk reduction of HF/death in response to CRT-D therapy when compared to ICD patients. However, among those with non-ischemic cardiomyo-pathy, obese patients with MS experienced a 90% reduction for HF/death (HR 0.11, 95% CI 0.04-0.32, p < 0.001), whereas obese patients without MS had no reduction (HR 0.98, 95% CI 0.48-1.98, p = 0.951; interaction p < 0.001). The reverse was observed in ischemic car-diomyopathy patients: obese patients with MS had no reduction in the risk of HF/death (HR 0.80, 95% CI 0.48-1.34, p = 0.402), while obese patients without MS showed a significant reduction in the risk of events (HR 0.15, 95% CI 0.04-0.65, p = 0.011; interaction p = 0.036). Similar trends were observed for the endpoint of death.
Presence of MS differentiates the response to CRT in obese patients with is-chemic and non-ischemic etiology for HF.
尽管代谢综合征（MS）与缺血性心脏病之间的关联已得到充分证实，但尚不清楚MS的存在是否会对心脏再同步治疗（CRT）的临床反应产生不同影响。本研究的目的是评估肥胖和代谢特征与心脏再同步除颤治疗（CRT-D）后的临床结局之间的关联，并与植入式心律转复除颤器（ICD）进行比较。
在多中心自动除颤器植入试验心脏再同步治疗（MADIT-CRT）中，对829例非肥胖患者、156例无MS的肥胖患者和277例患有MS的肥胖患者（均为左束支传导阻滞）进行了心力衰竭（HF）或死亡风险以及单独死亡风险的评估。
与接受ICD治疗的患者相比，患有MS的肥胖患者（HR 0.50，95%CI 0.32-0.77，p = 0.002）、无MS的肥胖患者（HR 0.57，95%CI 0.30-1.06，p = 0.077）以及非肥胖患者（HR 0.48，95%CI 0.37-0.62，p < 0.001）在接受CRT-D治疗后，HF/死亡风险降低情况相似。然而，在非缺血性心肌病患者中，患有MS的肥胖患者HF/死亡风险降低了90%（HR 0.11，95%CI 0.04-0.32，p < 0.001），而无MS的肥胖患者则没有降低（HR 0.98，95%CI 0.48-1.98，p = 0.951；交互作用p < 0.001）。在缺血性心肌病患者中观察到相反情况：患有MS的肥胖患者HF/死亡风险没有降低（HR 0.80，95%CI 0.48-1.34，p = 0.402），而无MS的肥胖患者事件风险显著降低（HR 0.15，95%CI 0.04-0.65，p = 0.011；交互作用p = 0.036）。对于死亡终点也观察到类似趋势。
MS的存在使缺血性和非缺血性病因导致HF的肥胖患者对CRT的反应有所不同
