How many patients with heart failure are eligible for cardiac resynchronization? Insights from two prospective cohorts
How many patients with heart failure are eligible for cardiac resynchronization? Insights from two prospective cohorts
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DOI：
10.1093/eurheartj/ehi446
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发表时间：
2006-02-01
影响因子：
39.3
通讯作者：
Armstrong, PW
中科院分区：
文献类型：
--
作者：
McAlister, FA;Tu, JV;Armstrong, PW
目的探讨心脏再同步化治疗（CRT）在心力衰竭患者中的适用比例。方法和结果：确立CRT疗效的试验的合格标准应用于两个前瞻性队列：第一组纳入1999年4月至2001年3月从103家医院出院的新诊断心力衰竭患者（“出院队列”）；第二组纳入了2003年8月至2004年1月在专科诊所就诊的患者（“专科诊所队列”）。在出院队列中，73例患者（2640例缺血性或扩张性心肌病患者中的3%，9096例出院心力衰竭患者中的1%）符合试验资格标准：LVEF = 120 ms，窦性心律，尽管接受了ace抑制剂/血管紧张素受体阻滞剂和β受体阻滞剂治疗，但仍有NYHA III或IV级症状。在专科临床队列中，54例患者（263例缺血性或扩张性心肌病患者中的21%和309例心力衰竭患者中的17%）符合这些标准。如果服用螺内酯后仍有持续症状，则符合CRT资格的比例在出院队列中降至1%，在专科诊所队列中降至18%。结论心力衰竭患者符合CRT试验条件的患者极少。
Aims To determine what proportion of patients with heart failure are eligible for cardiac resynchronization therapy (CRT).Methods and results Eligibility criteria from the trials establishing the efficacy of CRT were applied to two prospective cohorts: the first enrolled patients with newly diagnosed heart failure discharged from 103 hospitals between April 1999 and March 2001 ('the hospital discharge cohort'); the second enrolled patients seen in a specialized clinic between August 2003 and January 2004 ('the specialty clinic cohort'). In the hospital discharge cohort, 73 patients (3% of the 2640 patients with ischaemic or dilated cardiomyopathy and 1% of all 9096 patients with heart failure discharged alive) met trial eligibility criteria: LVEF = 120 ms, sinus rhythm, and NYHA class III or IV symptoms despite the treatment with ACE-inhibitor/angiotensin receptor blocker and beta-blocker. In the specialty clinic cohort, 54 patients (21% of the 263 patients with ischaemic or dilated cardiomyopathy and 17% of all 309 patients with heart failure) met these criteria. If persistent symptoms despite taking spironolactone were required for CRT eligibility, then the proportions qualifying dropped to 1% in the hospital discharge cohort and 18% in the specialty clinic cohort.Conclusion Few heart failure patients meet trial eligibily criteria for CRT.