对扩张型心肌病患者预防性植入埋藏式心脏复律除颤器对左室功能的影响  

Prophylactic implantable cardioverter defibrillator therapy in dilated cardiomyopathy:Impact of left ventricular function

作　　者：Schaer B. A. Ammann P. Sticherling C. 黄浙勇(译) 任付先(校) 

机构地区：[1]Department of Cardiology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland [2]不详

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2006年第8期34-34,共1页

摘　　要：Background: The value of an implantable cardioverter defibrillator(ICD) for primary prevention in dilated cardiomyopathy(DCM) is unclear, as randomized trials could not show a survival benefit compared to drug therapy. It has not been investigated if patients with a very poor left ventricular function(LVEF) could profit from an ICD. Methods: Consecutive patients with DCM who received an ICD between December 1996 and November 2003 were included in this analysis. Patients were divided in group A(secondary prevention) and group B(primary prevention). Both groups were stratified in subgroups with left ventricular ejection fraction(LVEF) below and above 20% . Results: Fifty eight patients were included(male 50, age 56.4± 12.7 years). Follow-up was 34± 19 months. There was no difference regarding death(18% vs. 11% ), but significant differences(p value< 0.05) regarding any adverse events(55% vs. 22% ), any ICD intervention(48% vs. 17% ) and ICD interventions for life-threatening arrhythmias(27% vs. 0% )between group A and B. LVEF was not predictive for events in group A, whereas in group B only patients with a LVEF< 20% had events(p value 0.02). Over time there was an increase of the LVEF of more than 15% determined by echocardiography in 36% of patients, significantly more often in group B. Conclusions: Indication for primary prevention with an ICD in DCM should be made with caution. Larger studies are needed to determine if patients with LVEF of< 20% might benefit from an ICD.Background： The value of an implantable cardioverter defibrillator（ICD） for primary prevention in dilated cardiomyopathy （DCM） is unclear, as randomized trials could not show a survival benefit compared to drug therapy. It has not been investigated if patients with a very poor left ventricular function（LVEF） could profit from an ICD. Methods： Consecutive patients with DCM who received an ICD between December 1996 and November 2003 were included in this analysis. Patients were divided in group A（secondary prevention） and group B （primary prevention） . Both groups were strati- fied in subgroups with left ventricular ejection fraction （LVEF） below and above 20%. Results： Fifty eight patients were included（male 50, age 56.4 ± 12.7 years） Follow-up was 34 ± 19 months. There was no difference regarding death（18% vs. 11% ）, but significant differences （p value 〈 0. 05 ） regarding any adverse events（55% vs. 22% ）, any ICD intervention（48% vs. 17% ） and ICD interventions for life-threatening arrhythmias（27% vs. 0% ） between group A and B. LVEF was not predictive for events in group A, whereas in group B only patients with a LVEF 〈 20% had events （p value 0.02）. Over time there was an increase of the LVEF of more than 15% determined by echocardiography in 36% of patients, significantly more often in group B. Conclusions： Indication for primary prevention with an ICD in DCM should be made with caution. Larger studies are needed to determine if patients with LVEF of 〈 20% might benefit from an ICD.

关 键 词：植入埋藏式心脏复律除颤器 扩张型心肌病患者 左室功能 预防性 ICD治疗 超声心动图检查 一级预防 临床试验结果 左室射血分数 LVEF 

分 类 号：R541[医药卫生—心血管疾病] R542.2[医药卫生—内科学]