Eligibility for cardiac resynchronization therapy in patients hospitalized with heart failure
Eligibility for cardiac resynchronization therapy in patients hospitalized with heart failure
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DOI：
10.1002/ehf2.12297
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发表时间：
2018-08-01
影响因子：
3.8
通讯作者：
Virani, Sean A.
中科院分区：
文献类型：
--
作者：
Osmanska, Joanna;Hawkins, Nathaniel M.;Virani, Sean A.
目的最近的指南推荐对轻度症状性心力衰竭(HF)患者进行心脏再同步治疗(CRT)，但对中度QRS延长(120-150ms)的患者推荐左束支传导阻滞(LBBB)的形态。我们定义了有多少心力衰竭患者符合这些标准。方法和结果：对连续363例心力衰竭患者(438例住院)进行了单中心回顾性队列研究。我们回顾了电子成像、心电图仪和记录。总体而言，153名患者(42%)的左心室射血分数(LVEF)为35%，34%的患者QRS延长。80例(22%)患者可能符合LVEF35%和QRS120ms或现有CRT的条件。根据国际指南(LBBB或非LBBB QRS150ms或右室起搏)，大多数(68/80)患者有I或IIa类建议。只有少数人(12/80)有非LBBB形态的中度QRS延长。四分之一(n=22)符合标准的患者因痴呆症、合并症或姑息治疗等原因而不符合条件。另有8名患者需要优化药物治疗。因此，50名患者立即接受了CRT。在这些人中，29人被植入或拥有现有的CRT系统。符合CRT标准的80例患者中有21例(占住院患者总数的6%)没有确诊或接受治疗。结论在实际住院的老年心力衰竭患者中，22%的患者符合CRT的LVEF和QRS标准，大多数患者具有I级或IIa级适应症。然而，有很大一部分人由于并存或需要优化医疗条件而不符合条件。虽然CRT的使用量是合理的，但仍有改进的机会。
AimsRecent guidelines recommend cardiac resynchronization therapy (CRT) in mildly symptomatic heart failure (HF) but favour left bundle branch block (LBBB) morphology in patients with moderate QRS prolongation (120-150ms). We defined how many patients hospitalized with HF fulfil these criteria.Methods and resultsA single-centre retrospective cohort study of 363 consecutive patients hospitalized with HF (438 admissions) was performed. Electronic imaging, electrocardiograms, and records were reviewed. Overall, 153 patients (42%) had left ventricular ejection fraction (LVEF)35%, and 34% of patients had QRS prolongation. Eighty patients (22%) were potentially eligible with LVEF35% and QRS120ms or existing CRT. The majority (68 of 80) had a Class I or IIa recommendation according to international guidelines (LBBB or non-LBBB QRS150ms or right ventricular pacing). Only a minority (12 of 80) had moderate QRS prolongation of non-LBBB morphology. One-quarter (n=22) of patients fulfilling criteria were ineligible for reasons including dementia, co-morbidities, or palliative care. A further eight patients required optimization of medical therapy. CRT was therefore immediately indicated in 50 patients. Of these, 29 were implanted or had existing CRT systems. Twenty-one of the 80 patients eligible for CRT were not identified or treated (6% of the total hospitalized cohort).ConclusionsTwenty-two per cent of elderly real-life patients hospitalized with HF fulfil LVEF and QRS criteria for CRT, most having a Class I or IIa indication. However, a large proportion is ineligible owing to co-morbidities or requires medical optimization. Although uptake of CRT was reasonable, there remain opportunities for improvement.