Gandjbakhch Estelle, Rovani Marion, Varnous Shaida, Maupain Carole, Chastre Thomas, Waintraub Xavier, Pousset Françoise, Lebreton Guillaume, Duthoit Guillaume, Badenco Nicolas, Himbert Caroline, Leprince Pascal, Hidden-Lucet Françoise
Département de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Département de Cardiologie, Hôpital Saint-Joseph, 75015 Paris, France.
Arch Cardiovasc Dis. 2016 Aug-Sep;109(8-9):476-85. doi: 10.1016/j.acvd.2016.02.005. Epub 2016 Jun 22.
Implantable cardioverter-defibrillators (ICDs) are recommended in patients with low ejection fraction. However, the survival benefit of ICDs in patients with end-stage heart failure listed for heart transplantation is unclear.
To evaluate the ICD benefit on mortality in this population.
Three hundred and eighty consecutive patients listed for heart transplantation between 2005 and 2009 in one tertiary heart transplant centre were enrolled in a retrospective registry; 122 patients received an ICD before or within 3 months after being listed for heart transplantation (ICD group). Predictors of death on the waiting list were assessed by Cox regression.
Overall, 15.6% of patients died while awaiting heart transplantation. Non-ICD patients presented more often haemodynamic compromise requiring mechanical circulatory support (29.1% vs. 9.8%; P<0.001), and were more likely to die while on the waiting list (19.0% vs. 8.3%; log-rank P=0.001). However, in the multivariable model, ICD did not remain an independent predictor of death. Need for mechanical circulatory support (P<0.001), low ejection fraction (P=0.001) and registration on the regular list (P=0.008) were the only independent predictors of death. Death was mainly caused by haemodynamic compromise (76.3% of deaths), which occurred more frequently in the non-ICD group (14.7% vs. 5.8%; log-rank P=0.002). Unknown/arrhythmic deaths did not differ significantly between the two groups (3.9% vs. 1.7%; log-rank P=0.21). ICD-related complications occurred in 21.4% of patients, mainly as a result of postoperative worsening of heart failure (11.9%).
Haemodynamic failure appears as the main determinant of mortality in patients with end-stage heart failure awaiting heart transplantation. ICD seems to have little benefit on survival in this population.
射血分数低的患者推荐植入心脏复律除颤器（ICD）。然而，ICD对列入心脏移植名单的终末期心力衰竭患者的生存获益尚不清楚。
评估ICD对该人群死亡率的影响。
在一家三级心脏移植中心，对2005年至2009年间连续列入心脏移植名单的380例患者进行回顾性登记；122例患者在列入心脏移植名单之前或之后3个月内接受了ICD（ICD组）。通过Cox回归评估等待名单上死亡的预测因素。
总体而言，15.6%的患者在等待心脏移植期间死亡。非ICD患者更常出现需要机械循环支持的血流动力学损害（29.1%对9.8%；P<0.001），且在等待名单上死亡的可能性更大（19.0%对8.3%；对数秩检验P=0.001）。然而，在多变量模型中，ICD不再是死亡的独立预测因素。需要机械循环支持（P<0.001）、射血分数低（P=0.001）和列入常规名单（P=0.008）是仅有的死亡独立预测因素。死亡主要由血流动力学损害导致（76.3%的死亡病例），在非ICD组中更频繁发生（14.7%对5.8%；对数秩检验P=0.002）。两组间不明原因/心律失常性死亡无显著差异（3.9%对1.7%；对数秩检验P=0.21）。21.4%的患者发生了与ICD相关的并发症，主要是由于术后心力衰竭恶化（11.9%）。
血流动力学衰竭似乎是等待心脏移植的终末期心力衰竭患者死亡率的主要决定因素。ICD对该人群的生存似乎益处不大。
