Brandão Mariana, Almeida João Gonçalves, Fonseca Paulo, Monteiro Joel, Santos Elisabeth, Rosas Filipa, Nogueira Ribeiro José, Oliveira Marco, Gonçalves Helena, Primo João, Fontes-Carvalho Ricardo
Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
Cardiology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal.
Heart Rhythm O2. 2021 Dec 17;2(6Part B):671-679. doi: 10.1016/j.hroo.2021.06.009. eCollection 2021 Dec.
Upgrade to cardiac resynchronization therapy (CRT) is common in Europe, despite little and conflicting evidence.
To compare long-term clinical outcomes in a cohort of patients receiving de novo or upgrade to CRT.
Single-center retrospective study of 295 consecutive patients submitted to CRT implantation between 2007 and 2018. Upgraded and de novo patients complying with a dedicated follow-up protocol were compared in terms of clinical (NYHA class improvement without major adverse cardiac events [MACE] in the first year of follow-up) and echocardiographic (left ventricle end-systolic volume reduction of >15% during the first year) response.
No differences in the rate of clinical (59.3% vs 62.6%, = .765) or echocardiographic response (72.2% vs 71.9%, = .970) between groups were observed. Device-related complications were also comparable between groups (8.9% vs 8.4%, = .892). Occurrence of MACE and all-cause mortality were analyzed over a median follow-up of 3 (interquartile range 1-6) years: MACE occurred less frequently in the de novo group (hazard ratio [HR]: 0.55, 95% confidence interval [CI]: 0.34-0.90, = .018), but all-cause mortality was similar among groups (HR: 0.87, 95% CI: 0.46-1.64, = .684). Propensity score-matching analysis was performed to adjust for possible confounder variables. In the propensity-matched samples, all-cause mortality (HR: 1.26, 95% CI: 0.56-2.77, = .557) and MACE (HR: 0.84, 95% CI: 0.46-1.54, = .574) were comparable between upgrade and de novo patients.
Survival after upgrade to resynchronization therapy was comparable to de novo implants. Additionally, clinical and echocardiographic response to CRT in upgraded patients were similar to de novo patients.
尽管证据有限且相互矛盾，但在欧洲，升级为心脏再同步治疗（CRT）的情况很常见。
比较一组接受初次植入或升级为CRT治疗患者的长期临床结局。
对2007年至2018年间连续295例接受CRT植入的患者进行单中心回顾性研究。比较升级患者和初次植入患者在临床（随访第一年纽约心脏协会[NYHA]分级改善且无重大不良心脏事件[MACE]）和超声心动图（随访第一年左心室收缩末期容积减少>15%）方面的反应。
两组在临床反应率（59.3%对62.6%，P = 0.765）或超声心动图反应率（72.2%对71.9%，P = 0.970）上未观察到差异。两组的器械相关并发症也相当（8.9%对8.4%，P = 0.892）。在中位随访3年（四分位间距1 - 6年）期间分析了MACE的发生情况和全因死亡率：初次植入组MACE发生频率较低（风险比[HR]：0.55，95%置信区间[CI]：0.34 - 0.90，P = 0.018），但两组全因死亡率相似（HR：0.87，95% CI：0.46 - 1.64，P = 0.684）。进行倾向评分匹配分析以调整可能的混杂变量。在倾向评分匹配样本中，升级患者和初次植入患者的全因死亡率（HR：1.26，95% CI：0.56 - 2.77，P = 0.557）和MACE（HR：0.84，95% CI：0.46 - 1.54，P = 0.574）相当。
升级为再同步治疗后的生存率与初次植入相当。此外，升级患者对CRT的临床和超声心动图反应与初次植入患者相似。
