Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal.
Cardiology Department, V. N. Gaia Hospital Center, V. N. Gaia, Portugal.
Eur Heart J. 2019 Jul 1;40(26):2121-2127. doi: 10.1093/eurheartj/ehz238.
The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D).
A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10-42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3-45.5] and 97.2 (95% CI 85.5-109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79-1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45-2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death.
In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator.
心脏再同步治疗（CRT）后存活最初数年的患者的长期预后尚未得到很好的描述。我们旨在提供长期结果，特别是关于 CRT 患者（无 CRT-P 和有除颤器 CRT-D）中发生心源性猝死（SCD）的情况。
本项多中心欧洲观察性队列研究共纳入了 1775 名存活超过 CRT 植入后 5 年的缺血性或非缺血性扩张型心肌病患者。评估了总体长期死亡率和特定死因，重点关注晚期 SCD。在超过最初 5 年的平均 30 个月（10-42 个月的四分位间距）随访中，我们观察到 473 例死亡。CRT-D 和 CRT-P 患者的年标准化死亡率分别为 40.4 [95%置信区间（CI）35.3-45.5]和 97.2（95% CI 85.5-109.9）/1000 患者年。全因死亡率的调整后危险比（HR）为 0.99（95% CI 0.79-1.22）。共有 29 例患者总死于晚期 SCD（CRT-P 组 14 例，CRT-D 组 15 例），占两组设备患者所有死因的 6.1%。CRT-P 和 CRT-D 患者的特定年度 SCD 发生率分别为 8.5 和 5.8/1000 患者年，两组之间无显著差异（调整后 HR 1.0，95% CI 0.45-2.44）。进展性心力衰竭导致的死亡是主要死亡原因（CRT-P 患者中为 42.8%，CRT-D 患者中为 52.6%），而两组中约三分之一的死亡归因于非心血管死亡。
在 CRT 受者的首次长期预后描述中，进展性心力衰竭死亡仍然是 CRT 植入后最初 5 年内存活患者最常见的死亡原因。相比之下，无论是否存在除颤器，SCD 都是晚期死亡率的一个非常低的比例。
