Clinical Implications of Complete Left-Sided Reverse Remodeling With Cardiac Resynchronization Therapy A MADIT-CRT Substudy
Clinical Implications of Complete Left-Sided Reverse Remodeling With Cardiac Resynchronization Therapy A MADIT-CRT Substudy
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DOI：
10.1016/j.jacc.2016.06.051
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发表时间：
2016-09-20
影响因子：
24
通讯作者：
Kutyifa, Valentina
中科院分区：
文献类型：
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作者：
Mathias, Andrew;Moss, Arthur J.;Kutyifa, Valentina
背景 除颤器心脏再同步治疗 (CRT-D) 导致的完全左侧逆重构的临床意义尚不清楚，其定义为左心室收缩末期容积 (LVESV) 和左心房容积 (LAV) 均减少。 目的 本研究旨在评估入组的左束支传导阻滞 (LBBB) 的 CRT-D 患者中完全左侧逆重构对心力衰竭 (HF) 和死亡事件的发生率和预测价值。 MADIT-CRT（心脏再同步治疗的多中心自动除颤器植入试验）。 方法 研究人群包括 533 名患有 LBBB 的 CRT-D 患者，其中 212 名 (40%) 患有完全左侧逆重塑（LAV 和 LVESV 均高于中值变化），115 名 (22%) 患有不一致逆重塑（仅 LAV 高于中值变化）或 LVESV），206 例（38%）具有较小的逆重塑（LAV 和 LVESV 变化低于中值）。主要终点是心衰或死亡；次要终点包括长期随访期间仅发生心力衰竭和仅发生死亡。 结果 具有完全左侧逆重塑的患者的心力衰竭或死亡率显着低于逆重塑不一致或逆重塑程度较低的患者（p < 0.001）。多变量 Cox 比例风险模型一致显示，与不一致逆重构或较小逆重构的患者相比，完全逆重构患者的心衰和死亡风险降低（风险比：每组 0.66；95% CI：0.50 至 0.85；p = 0.002）。对于单独的心力衰竭和单独的死亡，这一发现是相似的。 结论 在 MADIT-CRT 中，> 20% 的 CRT-D 患者在左心室和左心房表现出不一致的逆重塑。与逆重塑不一致或较轻的患者相比，患有 LBBB 和完全左侧逆重塑的 CRT-D 患者在长期随访期间发生心力衰竭和死亡、单纯心力衰竭和单纯死亡的风险显着较低。 （MADIT-CRT：采用心脏再同步治疗的多中心自动除颤器植入 [MADIT-CRT]；NCT00180271）(C) 2016 年，美国心脏病学会基金会。
BACKGROUND Clinical implications of complete left-sided reverse remodeling due to cardiac resynchronization therapy with a defibrillator (CRT-D), defined as reduction in both left ventricular end-systolic volume (LVESV) and left atrial volume (LAV), are unknown.OBJECTIVES This study aimed to evaluate the rate and predictive value of complete left-sided reverse remodeling on heart failure (HF) and death events in CRT-D patients with left bundle branch block (LBBB) enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy).METHODS The study population comprised 533 CRT-D patients with LBBB, 212 (40%) with complete left-sided reverse remodeling (above-median change in both LAV and LVESV), 115 (22%) with discordant reverse remodeling (above-median change in only LAV or LVESV), and 206 (38%) with lesser reverse remodeling (below-median LAV and LVESV change). The primary endpoint was HF or death; secondary endpoints included HF alone and death alone during long-term follow-up.RESULTS Patients with complete left-sided reverse remodeling had a significantly lower rate of HF or death than those with discordant reverse remodeling or lesser reverse remodeling (p < 0.001). Multivariate Cox proportional hazard models consistently showed a decreased risk for HF and death in patients with complete reverse remodeling compared with discordant reverse remodeling or lesser reverse remodeling (hazard ratio: 0.66 per each group; 95% CI: 0.50 to 0.85; p = 0.002). This finding was similar for HF alone and death alone.CONCLUSIONS In MADIT-CRT, > 20% of CRT-D patients exhibited discordant reverse remodeling in the left ventricle and the left atrium. CRT-D patients with LBBB and complete left-sided reverse remodeling had a significantly lower risk of HF and death, HF alone, and death alone during long-term follow-up than patients with discordant or lesser reverse remodeling. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271) (C) 2016 by the American College of Cardiology Foundation.