选择心脏再同步治疗起搏器或除颤器的影响因素分析  

Analysis of factors influencing the selection of cardiac resynchronization therapy pacemaker or defibril. lator（CRT-D or CRT-P）in Chinese patients with heart failure

作　　者：樊晓寒[1] 陈柯萍[1] 严激[2] 宿燕岗[3] 邹建刚[4] 王景峰[5] 苏晞[6] 华伟[1] 张澍[1] 

机构地区：[1]中国医学科学院 北京协和医学院 国家心血管病中心 心血管疾病国家重点实验室 阜外医院心律失常中心,100037 [2]安徽省立医院心内科 [3]复旦大学附属中山医院心脏科 [4]南京医科大学第一附属医院心脏科 [5]中山大学孙逸仙医院心内科 [6]武汉亚洲心脏病医院心内科

出　　处：《中华心律失常学杂志》2017年第1期31-36,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家科技支撑计划（2011BAI11802）

摘　　要：目的 指南推荐接受心脏再同步治疗起搏器（CRT-P）治疗的心力衰竭患者同时也有心脏再同步治疗除颤器（CRT-D）的植入适应证.但在临床实践中很多因素影响着CRT-P或CRT-D的选择.本研究旨在分析心力衰竭患者选择CRT-D的影响因素.方法 本研究为前瞻性的、多中心的、开放性注册研究,数据来源于心律失常介入治疗的数据库平台,连续入选从2013年5月至2015年11月于15个省（直辖市）22家医院接受CRT治疗的心力衰竭患者,排除临床资料缺失较多和更换脉冲发生器患者,收集患者基本临床资料,包括人口学资料、病因、病史、心电图、超声心动图资料等.按照医院所在省（直辖市）2014年国内生产总值（GDP）将医院分为3组（〉4万亿元,2～4万亿元,〈2万亿元）,分析GDP对CRT-D选择的影响.采用多因素logistic回归分析选择CRT-D的影响因素.结果 入选新植入CRT的454例患者,其中52.2％选择了CRT-D.选择CRT-D的患者年龄≥70岁的比例显著低于CRT-P（20.7％对30.0％,P=0.023）,左心室射血分数（LVEF）更低（30.5％对35.0％,P〈0.001）,伴有房室传导阻滞比例较低（8.9％对23.0％,P〈0.001）,左心室舒张末期内径更大（69 mm对65 mm,P〈0.001）,服用抗心律失常药物的比例更高（25.4％对7.1％,P〈0.001）,更高的室性心动过速/心室颤动（室速/室颤）史（29.7％对4.1％,P〈0.001）或晕厥病史（16.0％对9.5％,P=0.046）.医院CRT总植入量明显影响CRT-D的选择,除个别医院外,大多数植入量在40例以上的医院植入CRT-D的比例在54.9％～67.1％,年植入量15～40例的医院选择CRT-D比例较低（18.8％～35.3％）,植入量15例以下的医院选择CRT-D比例较高（76.9％～81.8％）.3组GDP不同选择CRT-D的比例差异有统计学意义（55.6％对54.5％对28.9％,P=0.005）.多因素logistic回归分析发现,室速/室颤史（OR 6.00;95％CI 2.67～13.47）、服用地高辛（OR 1.95;95％CI Objective Patients with heart failure meeting criteria for cardiac resynchronization therapy（CRT）pacemaker（CRT-P）could also receive implantable cardioverter defibrillator therapy（CRT-D）according to current guidelines.The selection of CRT-P or CRT-D is affected by many factors in clinical practice.The present study aimed to analyze factors influencing the selection of CRT-P or CRT-D in Chinese patients with heart failure. Methods This was a prospective,multicenter,and open registry study.Data were from the database platform for interventional therapy of arrhythmia.All heart failure patients more than 18 years old were consecutively enrolled from 22 hospitals in 15 provinces if they received a CRT device with or without ICD between May 2013 and November 2015.We collected patients＇ baseline clinical data,including demographic data,etiology,medical history,electrocardiogram（ECG）and echocardiography（UCG）data.Patients were excluded from this study if they had missing or invalid data or just requiring device replacement.All hospitals were divided into 3 groups（〈2 trillion RMB,2-4 trillion RMB and 〉4 trillion RMB）by the GDP levels of the province which the hospital is located for analyzing the impact of GDP level on the selection of CRT-D.Multivariable logistic regression analysis was used to identify determinants of CRT-D.Results A total of 454 patients receiving new implant of CRT were included into this study,and 52.2%of them received CRT-D implantation.Compared with patients receiving CRT-P,patients receiving CRT-D had less proportion of elderly more than 70 years old（20.7%vs.30.0%,P=0.023）,lower left ventricular ejection fractions（LVEF,30.5%vs.35.0%,P〈0.001）,less atrioventricular block（8.9%vs.23.0%,P〈0.001）,larger left ventricular end-diastolic diameter（69 mm vs.65 mm,P〈0.001）,more common taking antiarrhythmic drugs（25.4%vs.7.1%,P〈0.001）,and more common having ventricular arrhythmias（29.7%vs.4.1%,P〈0.001）or syncope（16.0%vs.9.5%,P=0.046）.The selectio

关 键 词：心脏再同步治疗 植入型心律转复除颤器 影响因素 心力衰竭 注册研究 

分 类 号：R541.6[医药卫生—心血管疾病]