Erath Julia W, Vigh Nikolett, Muk Balazs, Israel Carsten W, Keck Sarah, Pilecky David, Duray Gabor Z, Vamos Mate
Department of Cardiology, Goethe University Hospital, 60590 Frankfurt am Main, Germany.
Department of Cardiology, Medical Centre, Hungarian Defense Forces, 1062 Budapest, Hungary.
J Cardiovasc Dev Dis. 2024 Jun 3;11(6):173. doi: 10.3390/jcdd11060173.
(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months ± 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88-1.5; = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75-1.45; = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72-1.70; = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA < 0.01; LVEF < 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock ( = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40-0.85; = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up.
(1) 引言：在重度心力衰竭患者中使用洋地黄存在争议。我们在一项针对心脏再同步治疗（CRT）接受者的大型观察性研究中评估了洋地黄治疗对死亡率的影响。(2) 方法：在三个欧洲三级转诊中心连续纳入接受CRT除颤器的患者，并进行平均37个月±28个月的随访。在CRT植入时评估洋地黄的使用情况。使用多变量Cox回归模型和倾向评分匹配来确定全因死亡率作为主要终点。在一组患者中，将CRT反应（定义为纽约心脏协会[NYHA]心功能分级改善≥1级）、超声心动图改善（定义为左心室射血分数[LVEF]改善≥5%）以及植入式心律转复除颤器（ICD）电击和再住院发生率作为次要终点进行评估。(3) 结果：该研究纳入了552例具有标准适应证的CRT接受者，其中219例（40%）接受了洋地黄治疗。与未使用洋地黄的患者相比，他们房颤更为常见，LVEF更差，NYHA心功能分级更高（所有P≤0.002）。全因死亡率的粗分析显示，使用和未使用洋地黄的患者死亡相对风险相似（风险比[HR]=1.14；95%置信区间[CI]0.88 - 1.5；P = 0.40）。在对死亡率的独立预测因素进行调整后，洋地黄治疗并未改变死亡风险（调整后HR = 1.04；95%CI 0.75 - 1.45；P = 0.82）。此外，与286例倾向评分匹配的患者相比，洋地黄摄入对死亡率没有影响（倾向调整后HR = 1.11；95%CI 0.72 - 1.70；P = 0.64）。在未使用洋地黄的患者中，CRT反应更为显著，在心力衰竭症状和LVEF改善方面均如此（NYHA分级P<0.01；LVEF P<0.01），而使用洋地黄的患者更常发生需要ICD电击的室性快速心律失常（P = 0.01）；尽管如此，与未使用洋地黄的患者相比，使用洋地黄的患者因心脏原因再次住院的情况显著更低（HR = 0.58；95%CI 0.40 - 0.85；P = 0.01）。(4) 结论：洋地黄治疗对死亡率没有影响，但与对CRT反应降低以及对需要ICD电击治疗的室性心律失常易感性增加有关。尽管如此，在随访期间洋地黄给药确实积极改变了心脏再住院的可能性。
