Leyva Francisco, Zegard Abbasin, Qiu Tian, de Bono Joseph, Thorne Sara, Clift Paul, Marshall Howard, Hudsmith Lucy
Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK.
Quality and Outcomes Research Unit, Queen Elizabeth Hospital, Birmingham, UK.
Pacing Clin Electrophysiol. 2019 Jun;42(6):573-580. doi: 10.1111/pace.13670. Epub 2019 Apr 17.
Randomized, controlled trials of cardiac resynchronization therapy (CRT) excluded patients with adult congenital heart disease (ACHD). We sought to explore long-term clinical outcomes.
In this single-center, observational study, events were collected from hospital records on patients with structural ACHD (sACHD) and adults with ischemic (ICM) or nonischemic (NICM) cardiomyopathy undergoing CRT. Patients with sACHD (n = 23, age: 41.6 ± 13.5 years [mean ± standard deviation]) and adults with ICM (n = 533) or NICM (n = 458) were followed-up for 4.1 years (median; interquartile range: 2.2-6.1). Total mortality was 5/23 (21.7%; 4.4 per 100 person-years) in sACHD, 221/533 (41.5%; 11.8 per 100 person-years) in ICM, and 154/458 (33.6%; 9.7 per 100 person-years) in NICM. In univariate analyses, total mortality in sACHD was lower than in ICM (hazard ratio [HR]: 0.38; 95% confidence interval [CI] 0.15-0.91), but similar to NICM (HR: 0.48, 95% CI 0.20-1.16). Cardiac mortality in sACHD was similar to ICM (HR: 0.78, 95% CI 0.32-1.92) and NICM (HR: 1.12, 95% CI 0.45-2.78). Heart failure (HF) hospitalization rates were similar to ICM (HR: 0.44, 95% CI 0.11-1.77) and NICM (HR: 0.75, 95% CI 0.18-3.08). In multivariate analyses, no differences emerged in total mortality, cardiac mortality, or HF hospitalization between sACHD and NICM or ICM, after adjustment for age, sex, New York Heart Association class, diabetes, atrial rhythm, QRS duration, QRS morphology, systemic ventricular ejection fraction, and medical therapy.
Total mortality, cardiac mortality, and HF hospitalization after CRT in patients with sACHD was similar to adults with ICM or NICM.
心脏再同步治疗（CRT）的随机对照试验排除了患有成人先天性心脏病（ACHD）的患者。我们试图探究其长期临床结局。
在这项单中心观察性研究中，我们从医院记录中收集了患有结构性ACHD（sACHD）的患者以及接受CRT的缺血性心肌病（ICM）或非缺血性心肌病（NICM）成人患者的相关事件。对sACHD患者（n = 23，年龄：41.6±13.5岁[均值±标准差]）以及ICM成人患者（n = 533）或NICM成人患者（n = 458）进行了4.1年的随访（中位数；四分位间距：2.2 - 6.1）。sACHD患者的总死亡率为5/23（21.7%；每100人年4.4例），ICM患者为221/533（41.5%；每100人年11.8例），NICM患者为154/458（33.6%；每100人年9.7例）。在单因素分析中，sACHD患者的总死亡率低于ICM患者（风险比[HR]：0.38；95%置信区间[CI] 0.15 - 0.91），但与NICM患者相似（HR：0.48，95% CI 0.
