Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium.
Faculty of Medicine and Life Sciences, UHasselt - Hasselt University, Agoralaan, Belgium.
Acta Cardiol. 2021 Nov;76(9):993-1000. doi: 10.1080/00015385.2020.1867387. Epub 2021 Jan 12.
The benefit of cardiac resynchronisation therapy (CRT) implantation in selected patients with heart failure is well known. The number of upgrade procedures is increasing but data on clinical response and outcome are less well documented as compared to implantation.
To investigate the efficacy and outcome of CRT upgrade procedures in patients with existing cardiac implantable electronic devices (CIEDs).
Baseline characteristics, change in New York Heart Association (NYHA) functional class, echocardiographic parameters, life-threatening ventricular tachyarrhythmias, all-cause mortality and mode of death were evaluated in CRT patients with the comparison between and upgrade CRT procedures.
About 410 patients (CRT upgrade/ CRT, = 97/313) were followed for 63.5 ± 38.1 months. Upgrade patients were older (75.5 ± 8.1 vs 69.9 ± 10.7 years; < 0.001), had more often an ischaemic cause of heart failure (58.8% vs 45.4%; = 0.021), a higher NYHA functional class ( = 0.004) and a higher comorbidity burden. Improvement in left ventricular ejection fraction (LVEF) was higher in the CRT group (8.4 ± 9.9 vs 11.0 ± 10.3%; = 0.035). Clinical response was similar between both groups (60.5 vs 62.5%; = 0.793), as was mortality at 1 year (8.2 vs 5.8%; = 0.351) and at last follow-up (33.0 vs 28.8%; = 0.447). The proportion of cardiovascular related deaths was similar between both groups (46.9% vs 38.9%; = 0.531).
Patients with CRT upgrade procedures have similar symptomatic improvements, as well as 1 year and long-term outcome as compared to patients with CRT implantation.
心脏再同步治疗（CRT）在选定的心力衰竭患者中的益处是众所周知的。升级手术的数量正在增加，但与植入相比，关于临床反应和结果的数据记录较少。
研究现有心脏植入电子设备（CIED）患者中 CRT 升级手术的疗效和结果。
评估 CRT 患者的基线特征、纽约心脏协会（NYHA）功能分级的变化、超声心动图参数、危及生命的室性心动过速/心室颤动、全因死亡率和死亡方式，并将 CRT 升级与 CRT 进行比较。
大约 410 名患者（CRT 升级/CRT，n=97/313）随访 63.5±38.1 个月。升级组患者年龄较大（75.5±8.1 岁 vs 69.9±10.7 岁； <0.001），更常患有缺血性心力衰竭（58.8% vs 45.4%； =0.021），NYHA 功能分级更高（ =0.004），合并症负担更高。左心室射血分数（LVEF）改善在 CRT 组更高（8.4±9.9% vs 11.0±10.3%； =0.035）。两组的临床反应相似（60.5% vs 62.5%； =0.793），1 年死亡率（8.2% vs 5.8%； =0.351）和最后一次随访时死亡率（33.0% vs 28.8%； =0.447）也相似。两组心血管相关死亡率的比例相似（46.9% vs 38.9%； =0.531）。
与接受 CRT 植入的患者相比，接受 CRT 升级手术的患者具有相似的症状改善以及 1 年和长期结果。
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