Hospital d'Olot i Comarcal de la Garrotxa, Emergency Department, Girona, Catalonia, Spain.
Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IrisCC), Girona, Catalonia, Spain.
Colomb Med (Cali). 2023 Dec 29;54(4):e2015850. doi: 10.25100/cm.v54i4.5850. eCollection 2023 Oct-Dec.
To determine the prevalence, characteristics, timing of implementation and prognosis of patients with left bundle branch block (LBBB) and acute heart failure (AHF) treated with cardiac resynchronization therapy (CRT) in a real-life registry.
We analysed the characteristics of patients with AHF and LBBB at the time of inclusion in the EAHFE (Epidemiology Acute Heart Failure Emergency) cohort to determine the indication for CRT, the timing of implementation and its impact on 10-year all-cause mortality.
729 patients with a median age of 82 years and there was a high burden of comorbidities and functional dependence. The median left-ventricle ejection fraction (LVEF) was 40%. Forty-six (6%) patients were treated with CRT at some point during follow-up, with a median time of delay for CRT implementation of 960 (IQR=1,147 days) and at least 108 more untreated patients fulfilled criteria for CRT. Patients receiving CRT were younger, had different comorbidities, less functional dependence (higher Barthel index) and lower LVEF values. The median follow-up was 5.7 years (95% CI: 5.6-5.8) and CRT was not associated with changes in 10-year mortality (adjusted HR 1.33, 95% CI: 0.72-2.48; p-value 0.4). When compared with untreated patients fulfilling criteria for CRT, very similar results were observed (adjusted HR 1.34, 95% CI: 0.67-2.68).
CRT implementation was delayed and underused in patients with AHF and LBBB. Under these circumstances, CRT is not associated with a reduction in all-cause mortality in the long term.
在真实世界的注册研究中，确定接受心脏再同步治疗（CRT）的左束支传导阻滞（LBBB）和急性心力衰竭（AHF）患者的患病率、特征、实施时间和预后。
我们分析了 EAHFE（急性心力衰竭急诊流行病学）队列中纳入时伴有 AHF 和 LBBB 的患者的特征，以确定 CRT 的适应证、实施时间及其对 10 年全因死亡率的影响。
729 例患者的中位年龄为 82 岁，合并症和功能依赖性负担较高。中位左心室射血分数（LVEF）为 40%。46 例（6%）患者在随访期间的某个时间点接受了 CRT 治疗，CRT 实施的中位延迟时间为 960 天（IQR=1147 天），至少还有 108 例未接受 CRT 治疗的患者符合 CRT 标准。接受 CRT 的患者年龄较小，合并症不同，功能依赖性较低（较高的巴氏指数），LVEF 值较低。中位随访时间为 5.7 年（95%CI：5.6-5.8），CRT 与 10 年死亡率变化无关（校正 HR 1.33，95%CI：0.72-2.48；p 值 0.4）。与符合 CRT 标准但未接受治疗的患者相比，观察到非常相似的结果（校正 HR 1.34，95%CI：0.67-2.68）。
在 AHF 和 LBBB 患者中，CRT 的实施被延迟且未得到充分利用。在这种情况下，长期来看 CRT 并不能降低全因死亡率。
