Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Eur J Heart Fail. 2018 Jan;20(1):152-160. doi: 10.1002/ejhf.975. Epub 2017 Sep 27.
Heart transplantation (HTx) and implantable left ventricular assist systems (LVAS) improve outcomes in advanced heart failure but may be underutilized. We hypothesized that screening can identify appropriate candidates.
The ScrEEning for advanced Heart Failure treatment (SEE-HF) study was a multicentre prospective study screening patients with existing cardiac resynchronization therapy (CRT) and/or implantable cardioverter-defibrillator (ICD) for ejection fraction ≤40% and New York Heart Association (NYHA) class III-IV, and subsequently for guideline-based HTx and LVAS indication. Of 1722 (mean age 64 ± 14 years, 26% women) patients screened at eight centres in seven European countries, 121 (7.0%) were eligible and 99 (5.7%; mean age 61 ± 10 years, 19% women) patients were enrolled for detailed assessment. Twenty-six of the 99 enrolled patients (26%) were eligible for either HTx or LVAD (18 eligible for HTx; 7 eligible for LVAD; and 1 eligible for both). Eleven patients were listed for HTx and three received an LVAS. Eligible patients were 61 ± 8 years and 19% women, whereas those actually receiving intervention were 56 ± 8 years and 8% women.
Among patients with CRT and/or ICD, a minority have NYHA class III-IV heart failure and ejection fraction ≤40%. Among these, however, more than one-quarter have an unrecognized need for HTx or LVAS. When patients are offered intervention based on screening, many decline. Discrepancies exist between clinical and patient equipoise. Clinical Trial Registration ClinicalTrials.gov Unique Identifier: NCT00894387.
心脏移植（HTx）和植入式左心室辅助系统（LVAS）可改善晚期心力衰竭患者的预后，但可能未得到充分利用。我们假设筛查可以识别合适的患者。
ScrEEning for advanced Heart Failure treatment（SEE-HF）研究是一项多中心前瞻性研究，对已接受心脏再同步治疗（CRT）和/或植入式心脏转复除颤器（ICD）的患者进行筛查，以确定射血分数≤40%且纽约心脏协会（NYHA）心功能分级 III-IV 级的患者，并随后根据指南确定 HTx 和 LVAS 的适应证。在七个欧洲国家的八个中心筛查了 1722 例（平均年龄 64±14 岁，26%为女性）患者，其中 121 例（7.0%）符合条件，99 例（5.7%；平均年龄 61±10 岁，19%为女性）患者纳入详细评估。在 99 例纳入的患者中，有 26 例（26%）符合 HTx 或 LVAD 的适应证（18 例适合 HTx；7 例适合 LVAD；1 例适合两者）。11 例患者接受 HTx 治疗，3 例患者接受 LVAS。符合条件的患者年龄为 61±8 岁，其中 19%为女性，而实际接受干预的患者年龄为 56±8 岁，其中 8%为女性。
在接受 CRT 和/或 ICD 的患者中，少数患者存在 NYHA 心功能分级 III-IV 级和射血分数≤40%的心力衰竭。然而，在这些患者中，超过四分之一的患者有未被识别的 HTx 或 LVAS 需求。当根据筛查为患者提供干预时，许多人拒绝。临床和患者平衡之间存在差异。临床试验注册 临床试验.gov 唯一标识符：NCT00894387。
