仅采用植入式心脏复律除颤器预防治疗的缺血性和非缺血性心力衰竭患者的生存和心律失常风险：倾向评分匹配分析。

Survival and arrhythmic risk among ischemic and non-ischemic heart failure patients with prophylactic implantable cardioverter defibrillator only therapy: A propensity score-matched analysis.

机构信息

Hospital Universitario Infanta Leonor, Madrid, Spain.

出版信息

Int J Cardiol. 2019 Jan 1;274:163-169. doi: 10.1016/j.ijcard.2018.09.003. Epub 2018 Sep 5.

DOI:10.1016/j.ijcard.2018.09.003

PMID:30206014

Abstract

BACKGROUND

Concerns about the efficacy of prophylactic ICD in non-ischemic cardiomyopathy (NICM) heart failure (HF) patients are still present. We aimed to assess whether survival and arrhythmic risk were different among ischemic cardiomyopathy (ICM) and NICM ICD-only patients, along with specific predictors for mortality.

METHODS

HF patients undergoing ICD-only implant were extracted from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.

RESULTS

782 patients (556 ICM; 226 NICM) were recruited: mean ejection fraction of 26.6%; 83.4% in NYHA class II-III; mean QRS duration of 108.9 ms (only 14.9% with QRS > 130 ms). After 4.35 years of mean follow-up, all-cause mortality rate was 4.2%/year. In propensity-score (PS) analysis no survival differences between ICM and NICM subgroups appeared (mortality rates: 19.4% vs. 20%, p = 0.375). Age (hazard ratio [HR] = 1.02, p = 0.009), diabetes (HR = 2.61, p ≤ 0.001), chronic obstructive pulmonary disease (HR = 2.13, p = 0.002), and previous HF (HR = 2.28, p = 0.027) correlated with increased mortality for the entire population, however atrial fibrillation (AF) (HR = 2.68, p = 0.002) and chronic kidney disease (HR = 3.74, p ≤ 0.001) emerged as specific predictors in NICM patients. At follow-up, 134 patients (17.1%) were delivered a first appropriate ICD therapy (5.1%/year) without significant differences between ICM and NICM patients in the PS analysis (17.6% vs. 15.8%, p = 0.968). ICD shocks were associated with a higher mortality (HR = 2.88, p < 0.001) but longer detection windows (HR = 0.57, p = 0.042) correlated with fewer appropriate therapies.

CONCLUSIONS

Mortality and arrhythmia free survival is similar among ICM and NICM HF patients undergoing ICD-only implant for primary prevention strategy.

摘要

背景

对于非缺血性心肌病（NICM）心力衰竭（HF）患者，预防性 ICD 的疗效仍存在担忧。我们旨在评估缺血性心肌病（ICM）和 NICM ICD 仅患者的生存率和心律失常风险是否不同，并确定具体的死亡率预测因素。

方法

从全国多中心 UMBRELLA 登记处提取仅接受 ICD 植入的 HF 患者。心律失常事件通过远程监测收集，并由专家委员会进行审查。

结果

共纳入 782 例患者（556 例 ICM；226 例 NICM）：平均射血分数为 26.6%；83.4%在 NYHA 心功能 II-III 级；平均 QRS 持续时间为 108.9ms（仅 14.9%的 QRS>130ms）。在平均 4.35 年的随访后，全因死亡率为 4.2%/年。在倾向评分（PS）分析中，ICM 和 NICM 亚组之间的生存率无差异（死亡率：19.4% vs. 20%，p=0.375）。年龄（风险比[HR] = 1.02，p=0.009）、糖尿病（HR=2.61，p≤0.001）、慢性阻塞性肺疾病（HR=2.13，p=0.002）和既往 HF（HR=2.28，p=0.027）与全人群死亡率增加相关，但心房颤动（AF）（HR=2.68，p=0.002）和慢性肾脏病（HR=3.74，p≤0.001）在 NICM 患者中成为特定的预测因素。随访期间，共有 134 例患者（17.1%）接受了首次适当的 ICD 治疗（5.1%/年），在 PS 分析中，ICM 和 NICM 患者之间无显著差异（17.6% vs. 15.8%，p=0.968）。ICD 电击与更高的死亡率相关（HR=2.88，p<0.001），但更长的检测窗口（HR=0.57，p=0.042）与更少的适当治疗相关。