ICD 植入对心脏淀粉样变患者心血管结局的影响：系统评价和荟萃分析。

Effect of ICD implantation on cardiovascular outcomes in patients with cardiac amyloidosis: A systematic review and meta-anaylsis.

机构信息

Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri.

Biostatistics Design Unit, University of Missouri School of Medicine, Columbia, Missouri.

出版信息

J Cardiovasc Electrophysiol. 2020 Jul;31(7):1749-1758. doi: 10.1111/jce.14541. Epub 2020 Jun 13.

DOI:10.1111/jce.14541

PMID:32391952

Abstract

INTRODUCTION

Cardiac amyloidosis is associated with a high rate of sudden cardiac death (SCD). Whether implantable cardioverter-defibrillator (ICD) use in such patients prevents SCD is uncertain. This study assesses outcomes of ICD use in patients with cardiac amyloidosis.

METHODS

A systematic review and meta-analysis of data were performed after searching multiple databases and scientific sites pertaining to ICD use and cardiac amyloidosis. Of 8260 citations identified, six studies comprising 194 patients met inclusion criteria.

RESULTS

Mean values and frequencies of patient characteristics were as follows: mean NT-proBNP: 6867.9 pg/mL, mean left ventricular ejection fraction: 48.1%, heart failure: 67%, nonsustained ventricular tachycardia: 51%, syncope: 21%, and secondary prevention: 33%. During the mean follow-up period of 18.21 months, 18% of patients received appropriate ICD treatment and 5% received inappropriate ICD treatment. The mortality rate was 31%. Two studies assessed the difference between patients with appropriate ICD treatment and patients with absence of appropriate ICD treatment. There was no difference between the two groups when stratified on multiple selected third variables except for two subgroups. Male gender was associated with a higher rate of appropriate ICD treatment, whereas New York Heart Association class III or IV heart failure patients was associated with a lower rate of appropriate ICD treatment.

CONCLUSION

The frequency of appropriate ICD treatment in cardiac amyloidosis is low and is not predicted by nonsustained ventricular tachycardia. Male gender is associated with appropriate ICD treatment. New York Heart Association class III or IV heart failure is associated with lower rate of appropriate ICD treatment.

摘要

简介

心脏淀粉样变性与较高的心脏性猝死（SCD）发生率相关。植入式心脏复律除颤器（ICD）在这类患者中的应用是否能预防 SCD 尚不确定。本研究评估了 ICD 在心脏淀粉样变性患者中的应用结局。

方法

通过检索多个数据库和与 ICD 使用及心脏淀粉样变性相关的科学网站，对数据进行了系统回顾和荟萃分析。在 8260 条引文中共纳入了 6 项研究，共纳入 194 例患者。

结果

患者特征的平均值和频率如下：平均 NT-proBNP：6867.9 pg/mL，平均左心室射血分数：48.1%，心力衰竭：67%，非持续性室性心动过速：51%，晕厥：21%，二级预防：33%。在平均 18.21 个月的随访期间，18%的患者接受了适当的 ICD 治疗，5%的患者接受了不适当的 ICD 治疗。死亡率为 31%。有两项研究评估了接受适当 ICD 治疗与未接受适当 ICD 治疗的患者之间的差异。除了两个亚组外，在多个选定的第三变量分层时，两组之间没有差异。男性与适当 ICD 治疗率较高相关，而纽约心脏协会（NYHA）心功能 III 或 IV 级心力衰竭患者与适当 ICD 治疗率较低相关。