Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Free University Brussels (VUB), University Hospital Brussels (UZ Brussel), Brussels, Belgium.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Cardiol. 2023 Jun 15;197:34-41. doi: 10.1016/j.amjcard.2023.03.026. Epub 2023 May 2.
Cardiac resynchronization therapy (CRT) is an effective therapy in selected patients with advanced heart failure that reduces all-cause mortality at short-term follow-up. However, data regarding long-term mortality after CRT implantation are scarce, with no separate analysis available of the covariates associated with respectively short-term and long-term outcomes. Accordingly, the present study evaluated the risk factors associated with short-term (2-year follow-up) versus long-term (10-year follow-up) mortality after CRT implantation. Patients who underwent CRT implantation and had echocardiographic evaluation before implantation were included in the present study. The primary end point was all-cause mortality, and independent associates of short-term (2-year follow-up) and long-term (10-year follow-up) mortality were compared. In total, 894 patients (mean age 66 ± 10 years, 76% males) who underwent CRT implantation were included in the present study. The cumulative overall survival rates for the total population were 91%, 71%, and 45% at 2-, 5- and 10-year follow-up, respectively. Multivariable Cox regression analysis showed that short-term mortality was associated with both clinical and echocardiographic variables at the moment of CRT implantation; whereas long-term mortality was predominantly associated with baseline clinical parameters and was less strongly associated with baseline echocardiographic parameters. In conclusion, at long-term (10-year) follow-up, a significant proportion (45%) of patients with advanced heart failure who underwent CRT implantation were still alive. Importantly, the risk assessment for short-term (2-year follow-up) and long-term (10-year follow-up) mortality differ considerably, which may influence clinical decision making.
心脏再同步治疗（CRT）是一种有效的治疗方法，适用于特定的晚期心力衰竭患者，可以降低短期随访时的全因死亡率。然而，关于 CRT 植入后的长期死亡率的数据很少，也没有分别分析与短期和长期结果相关的协变量。因此，本研究评估了 CRT 植入后短期（2 年随访）和长期（10 年随访）死亡率相关的危险因素。本研究纳入了接受 CRT 植入且植入前进行超声心动图评估的患者。主要终点是全因死亡率，并比较了短期（2 年随访）和长期（10 年随访）死亡率的独立相关因素。共纳入 894 例（平均年龄 66±10 岁，76%为男性）接受 CRT 植入的患者。总人群的累积总生存率分别为 91%、71%和 45%，随访 2、5 和 10 年。多变量 Cox 回归分析显示，短期死亡率与 CRT 植入时的临床和超声心动图变量均相关；而长期死亡率主要与基线临床参数相关，与基线超声心动图参数的相关性较弱。总之，在长期（10 年）随访中，接受 CRT 植入的晚期心力衰竭患者中有相当一部分（45%）仍存活。重要的是，短期（2 年随访）和长期（10 年随访）死亡率的风险评估差异很大，这可能会影响临床决策。
