心脏再同步治疗起搏器/除颤器对不同病因慢性心力衰竭患者长期生存预后的影响  

Effect of cardiac resynchronization therapy pacemaker/defibrillator on clinical outcomes in patients with ischemic and non-ischemic cardiomyopathy

作　　者：迪拉热·太外库力 约尔古丽·玉素甫 魏猛 刘佳琦 加依娜·加尔肯 周贤惠[1] 祖克拉·吐尔洪 李耀东[1] 邢强[1] 张疆华[1] 汤宝鹏[1] 芦颜美[1] Dilare·Taiwaikuli;Yueerguli·Yusufu;Wei Meng;Liu Jiaqi;Jiayina·Jiaerken;Zhou Xianhui;Zukela·Tuerhong;Li Yaodong;Xing Qiang;Zhang Jianghua;Tang Baopeng;Lu Yanmei(Department of Pacing and Electrophysiology,Department of Cardiac Electrophysiology and Remodeling,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心起搏电生理科,新疆心电生理与心脏重塑重点实验室,乌鲁木齐830054

出　　处：《中华心律失常学杂志》2022年第5期438-444,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：国家重点研发计划(2016YFC0900905);国家自然科学基金(81660071,81860081)。

摘　　要：目的旨在比较不同病因心力衰竭(心衰)患者植入心脏再同步治疗除颤器(CRT-D)/心脏再同步治疗起搏器(CRT-P)长期生存预后的差异。方法回顾性入选2015年1月至2020年1月在新疆医科大学第一附属医院心脏中心首次接受心脏再同步治疗(CRT)的患者,收集患者术前临床、心电图及超声心动图等基线资料,研究的主要终点事件为全因死亡事件,次要终点事件为临床复合事件的发生。根据病因将患者分为缺血性心肌病(ICM)组及非缺血性心肌病(NICM)组。比较ICM组及NICM组患者累积生存曲线(全因死亡率、无临床复合事件生存率),并用运用Cox回归分析所有患者的年龄、性别、QRS时限、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、心肌病类型、CRT类型、糖尿病及心房颤动合并症情况,并采用因子分析法及主成分回归法探究CRT患者发生全因死亡事件的影响因素。结果共入选214例患者,年龄(62.04±10.69)岁,其中女50例(23.4%,50/214),ICM组89例(41.6%,89/214),NICM组125例(58.4%,125/214)。中位随访32个月,共有57例患者发生全因死亡事件。Log-rank检验显示,在ICM组中,植入CRT-D患者的生存率高于CRT-P患者,差异有统计学意义(P=0.047);然而在NICM组患者中,不同CRT类型患者间生存率的差异无统计学意义(P=0.071)。对所有患者行Cox单因素及多因素分析提示,高龄(>70岁)及LVEF与全因死亡率相关。采用因子分析法及主成分回归法进行多因素二元Logistic回归分析后提示,CRT类型是患者发生全因死亡事件的影响因素(OR=1.486,95%CI 1.06~2.09,P=0.023)。结论ICM心衰患者,CRT-D与其长期生存改善相关,而在NICM心衰患者中不存在或减弱。Objective To compare the long-term survival outcomes of cardiac resynchronization therapy defibrillator(CRT-D)/cardiac resynchronization therapy pacemaker(CRT-P)implanted patients with different etiologies of heart failure(HF).Methods Patients who received CRT in the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2020 were retrospectively enrolled.The preoperative clinical,electrocardiogram,ultrasound data and other baseline data were collected.The primary endpoint was all-cause mortality,and the secondary endpoint was the occurrence of clinical composite event.Cumulative survival curves of patients with different CRT types in ischemic cardiomyopathy(ICM)group and non-ischemic cardiomyopathy(NICM)group were estimated(all-cause mortality,no incidence of composite clinical events),Cox regression analysis was carried out on CRT patients′age,gender,QRS duration,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,type of cardiomyopathy,CRT type as well as complications(atrial fibrillation,diabetes,and so on).Factor analysis and principal component regression were used to analyze the main influencing factors of all-cause mortality in CRT patients.Results Two hundred and fourteen patients were enrolled.The average age at baseline was(62.04±10.69)years.Among them,50(23.4%,50/214)were female.There were 89(41.6%,89/214)patients with ICM and 125(58.4%,125/214)patients with NICM.During the median follow-up period of 32 months,57 patients died of all causes.Log-rank test showed that in patients with ICM,the survival rate of patients with CRT-D was higher than that of patients with CRT-P(P=0.047),while there was no significant difference in the survival rate between patients with different CRT types in patients with NICM group(P=0.071).Cox univariate and multivariate analysis of all CRT patients suggested that advanced age(>70 years)and LVEF were associated with all-cause mortality.Multivariate binary Logistic regression analysis using f

关 键 词：心脏再同步治疗 缺血性心肌病 非缺血性心肌病 全因死亡率 远期随访 

分 类 号：R541.6[医药卫生—心血管疾病]