Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary.
University Hospital Frankfurt-Goethe University, Frankfurt am Main, Germany.
Heart Fail Rev. 2018 Jan;23(1):15-26. doi: 10.1007/s10741-017-9652-1.
Patients with conventional pacemakers or implanted defibrillators are often considered for cardiac resynchronization therapy (CRT). Our aim was to summarize the available evidences regarding the clinical benefits of upgrade procedures. A systematic literature search was performed from studies published between 2006 and 2017 in order to compare the outcome of CRT upgrade vs. de novo implantations. Outcome data on all-cause mortality, heart failure events, New York Heart Association (NYHA) Class, QRS narrowing and echocardiographic parameters were analysed. A total of 16 reports were analysed comprising 489,568 CRT recipients, of whom 468,205 patients underwent de novo and 21,363 upgrade procedures. All-cause mortality was similar after CRT upgrade compared to de novo implantations (RR 1.19, 95% CI 0.88-1.60, p = 0.27). The risk of heart failure was also similar in both groups (RR 0.96, 95% CI 0.70-1.32, p = 0.81). There was no significant difference in clinical response after CRT upgrade compared to de novo implantations in terms of improvement in left ventricular ejection fraction (ΔEF de novo - 6.85% vs. upgrade - 9.35%; p = 0.235), NYHA class (ΔNYHA de novo - 0.74 vs. upgrade - 0.70; p = 0.737) and QRS narrowing (ΔQRS de novo - 9.6 ms vs. upgrade - 29.5 ms; p = 0.485). Our systematic review and meta-analysis of currently available studies reports that CRT upgrade is associated with similar risk for all-cause mortality compared to de novo resynchronization therapy. Benefits on reverse remodelling and functional capacity improved similarly in both groups suggesting that CRT upgrade may be safely and effectively offered in routine practice.
Prospero Database-CRD42016043747.
总结升级程序临床获益的现有证据。
对 2006 年至 2017 年间发表的研究进行系统文献检索，比较 CRT 升级与初次植入的结果。分析全因死亡率、心力衰竭事件、纽约心脏协会（NYHA）分级、QRS 波变窄和超声心动图参数的预后数据。
共分析了 16 项研究，纳入 489568 例 CRT 接受者，其中 468205 例患者接受了初次植入，21363 例患者接受了升级。与初次植入相比，CRT 升级后的全因死亡率相似（RR 1.19，95%CI 0.88-1.60，p=0.27）。两组心力衰竭风险也相似（RR 0.96，95%CI 0.70-1.32，p=0.81）。与初次植入相比，CRT 升级后在改善左心室射血分数（升级后 EF 增加 9.35%，初次植入后 EF 增加 6.85%；p=0.235）、NYHA 分级（升级后 NYHA 改善 0.70，初次植入后 NYHA 改善 0.74；p=0.737）和 QRS 波变窄（升级后 QRS 波变窄 29.5ms，初次植入后 QRS 波变窄 9.6ms；p=0.485）方面无显著差异。
目前可用研究的系统综述和荟萃分析报告称，与初次同步化治疗相比，CRT 升级的全因死亡率风险相似。两组的逆向重构和功能能力的改善获益相似，提示 CRT 升级可在常规实践中安全有效地进行。
Zotero 插件
