The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Beijing 100037, China.
Europace. 2023 Aug 2;25(9). doi: 10.1093/europace/euad232.
Current guidelines lack clear recommendations between the implantation of cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) and CRT with pacemaker (CRT-P). We hypothesized that modified model for end-stage liver disease score including albumin (MELD-Albumin score), could be used to select patients who may not benefit from CRT-D. We consecutively included patients with CRT-P or CRT-D implantation between 2010 and 2022. The primary endpoint was the composite of all-cause mortality or worsening heart failure. We performed multivariable-adjusted Cox proportional hazard regression. We assessed the interaction between the MELD-Albumin score and the effect of adding a defibrillator with CRT.A total of 752 patients were included in this study, with 291 implanted CRT-P. During a median follow-up of 880 days, 205 patients reached the primary endpoint. MELD-Albumin score was significantly associated with the primary endpoint in the CRT-D group [HR 1.16 (1.09-1.24); P < 0.001] but not in the CRT-P group [HR 1.03 (0.95-1.12); P = 0.49]. There was a significant interaction between the MELD-Albumin score and the effect of CRTD (P = 0.013). The optimal cut-off value of the MELD-Albumin score was 12. For patients with MELD-Albumin ≥ 12, CRT-D was associated with a higher occurrence of the primary endpoint [HR 1.99 (1.10-3.58); P = 0.02], whereas not in patients with MELD-Albumin < 12 [HR 1.19 (0.83-1.70); P = 0.35). Our findings suggest that CRT-D is associated with an excess risk of composite clinical endpoints in HF patients with higher MELD-Albumin score.
目前的指南缺乏心脏再同步治疗（CRT）加除颤器（CRT-D）与 CRT 加起搏器（CRT-P）之间植入的明确建议。我们假设改良的终末期肝病模型评分包括白蛋白（MELD-白蛋白评分）可用于选择可能无法从 CRT-D 中获益的患者。我们连续纳入了 2010 年至 2022 年间植入 CRT-P 或 CRT-D 的患者。主要终点是全因死亡率或心力衰竭恶化的复合终点。我们进行了多变量调整的 Cox 比例风险回归。我们评估了 MELD-白蛋白评分与 CRT 加除颤器效果之间的交互作用。共有 752 例患者纳入本研究，其中 291 例植入 CRT-P。在中位随访 880 天期间，205 例患者达到了主要终点。MELD-白蛋白评分与 CRT-D 组的主要终点显著相关[HR 1.16（1.09-1.24）；P<0.001]，但与 CRT-P 组无关[HR 1.03（0.95-1.12）；P=0.49]。MELD-白蛋白评分与 CRT-D 的效果之间存在显著的交互作用（P=0.013）。MELD-白蛋白评分的最佳截断值为 12。对于 MELD-白蛋白≥12 的患者，CRT-D 与主要终点的发生率较高相关[HR 1.99（1.10-3.58）；P=0.02]，而 MELD-白蛋白<12 的患者则无此关联[HR 1.19（0.83-1.70）；P=0.35]。我们的研究结果表明，在 MELD-白蛋白评分较高的 HF 患者中，CRT-D 与复合临床终点的风险增加相关。
