扩张型心肌病与缺血性心肌病接受ICD一级预防治疗的预后比较  

Comparison of the benefit of primary prophylactic implantable cardioverter-defibrillator therapy on patients with ischemic cardiomyopathy and idiopathic dilated cardiomyopathy

作　　者：李佩雯[1] 许昕悦 许佳敏 赵金璇[1] 白剑[1] 蓝荣芳[1] 吉文庆[1] 王昆[1] 徐伟[1] LI Peiwen;XU Xinyue;XU Jiamin;ZHAO Jinxuan;BAI Jian;LAN Rongfang;JI Wenqing;WANG Kun;XU Wei(Department of Cardiology,Drum Tower Hospital,Medical School of Nanjing University,Nanjing,210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院心血管内科,南京210008

出　　处：《临床心血管病杂志》2021年第11期1031-1035,共5页Journal of Clinical Cardiology

基　　金：江苏省卫生健康委医学科研项目-重点项目(No:ZDB2020010)。

摘　　要：目的:探讨缺血性心肌病(ICM)患者和特发性扩张型心肌病(DCM)患者一期预防性植入心律转复除颤器(ICD)的获益是否存在差异。方法:回顾性纳入本中心53例DCM和25例ICM患者,所有患者均符合指南推荐的ICD或心脏再同步治疗除颤器(CRT-D)一级预防的适应证。收集患者入院植入ICD期间时的临床基线资料、治疗方案以及24 h动态心电图等资料。主要终点是全因死亡率,次要终点包括心源性猝死(SCD)和心血管死亡。结果:中位随访38.5个月,ICM组的8例患者(32.00%)和DCM组的5例患者(9.43%)发生了主要终点事件(P=0.012);ICM组5例(20.00%)发生心血管死亡,DCM组为3例(5.66%)(HR=0.119,95%CI0.016~0.860,P=0.035),差异有统计学意义。结论:在接受ICD植入作为SCD的一级预防治疗的患者中,DCM和ICM患者的获益无统计学差异。然而,与DCM患者相比,ICM患者由于更多地暴露于危险因素而具有更高的心血管病死率。Objective: To discuss the effect of primary prophylactic ICD implantation in patients with ischemic cardiomyopathy(ICM) or idiopathic dilated cardiomyopathy(DCM). Methods: We conducted a retrospective, single-center study, which enrolled 53 DCM patients and 25 ICM patients treated by primary prophylactic ICD or CRT-D. Clinical characteristics, medications, 24 h Holter electrocardiograms(ECGs) were recorded on admission. Primary end-point was all-cause mortality and secondary outcomes included SCD and cardiovascular death. Results: During a median follow-up of 38.5 months, the primary outcome occurred in 8 patients(32.00%) in the ICM group and 5 patients(9.43%) in the DCM group(P=0.012). Cardiovascular death occurred in 5 patients(20.00%) in the ICM group and 3 patients(5.66%) in the DCM group(HR0.119, 95%CI0.016 to 0.860, P=0.035). Conclusion: There is no statistical difference benefit between DCM and ICM groups among patients who received ICD implantation. However, ICM patients have a higher cardiovascular mortality due to more exposure in risk factors, compared with DCM patients.

关 键 词：缺血性心肌病 扩张型心肌病 心源性猝死 植入式心律转复除颤器 

分 类 号：R542.2[医药卫生—心血管疾病]