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

李佩雯; 许昕悦; 许佳敏; 赵金璇; 白剑; 蓝荣芳; 吉文庆; 王昆; 徐伟

doi:10.13201/j.issn.1001-1439.2021.11.012

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

- 南京大学医学院附属鼓楼医院心血管内科(南京, 210008)
基金项目:
江苏省卫生健康委医学科研项目-重点项目(No:ZDB2020010)

详细信息

通讯作者: 王昆,E-mail:kingwang726@163.com

中图分类号: R542.2

收稿日期: 2021-03-28

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

- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China

More Information

Corresponding author: WANG Kun, E-mail: kingwang726@163.com

Received Date: 28 March 2021

摘要

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。
- 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
Abstract: 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.
- ischemic cardiomyopathy /
- dilated cardiomyopathy /
- sudden cardiac death /
- implantable cardioverter defibrillator

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参考文献(21)

[1]	胡盛寿,高润霖,刘力生,等.《中国心血管病报告2018》概要[J].中国循环杂志,2019,34(3):209-220.
[2]	Thom T,Haase N,Rosamond W,et al.Heart disease and stroke statistics--2006 update:a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee[J].Circulation,2006,113(6):e85-151.
[3]	Sun WP,Li CL,Guo JC,et al.Long-term efficacy of implantable cardiac resynchronization therapy plus defibrillator for primary prevention of sudden cardiac death in patients with mild heart failure:an updated meta-analysis[J].Heart Fail Rev,2016,21(4):447-453.
[4]	Priori SG,Blomström-Lundqvist C,Mazzanti A,et al.2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death[J].Europace,2015,17(11):1601-1687.
[5]	Ponikowski P,Voors AA,Anker SD,et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J].Eur Heart J,2016,37(27):2129-2200.
[6]	Bänsch D,Antz M,Boczor S,et al.Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy:the Cardiomyopathy Trial(CAT)[J].Circulation,2002,105(12):1453-1458.
[7]	中华医学会心血管病学分会介入心脏病学组,中华医学会心血管病学分会动脉粥样硬化与冠心病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,等.稳定性冠心病诊断与治疗指南[J].中华心血管病杂志,2018,46(9):680-694.
[8]	中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志,2018,46(10):760-789.
[9]	Steinberg BA,Al-Khatib SM,Edwards R,et al.Outcomes of implantable cardioverter-defibrillator use in patients with comorbidities:results from a combined analysis of 4 randomized clinical trials[J].JACC Heart Fail,2014,2(6):623-629.
[10]	Køber L,Thune JJ,Nielsen JC,et al.Defibrillator implantation in patients with nonischemic systolic heart failure[J].N Engl J Med,2016,375(13):1221-1230.
[11]	Schaer BA,Kühne MS,Blatter D,et al.Application of a mortality risk score in a general population of patients with an implantable cardioverter defibrillator(ICD)[J].Heart,2014,100(6):487-491.
[12]	Barsheshet A,Moss AJ,Huang DT,et al.Applicability of a risk score for prediction of the long-term(8-year)benefit of the implantable cardioverter-defibrillator[J].J Am Coll Cardiol,2012,59(23):2075-2079.
[13]	冯义柏,黎明,谢培益,等.心肌梗死后早期猝死的ICD一级预防[J].临床心血管病杂志,2015,31(11):1147-1149.
[14]	Antiarrhythmics versus Implantable Defibrillators(AVID)Investigators.A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias[J].N Engl J Med,1997,337(22):1576-1583.
[15]	Hjalmarson A,Goldstein S,Fagerberg B,et al.Effects of controlled-release metoprolol on total mortality,hospitalizations,and well-being in patients with heart failure:the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure(MERIT-HF).MERIT-HF Study Group[J].JAMA,2000,283(10):1295-1302.
[16]	张昕,魏盟.置入型心律转复除颤器预防猝死的经验、困惑及临床评估[J].临床心血管病杂志,2008,24(11):877-880.
[17]	郭继鸿.ICD一级预防面临的挑战[J].临床心血管病杂志,2017,33(4):291-299.
[18]	Saba S,Atiga WL,Barrington W,et al.Selected patients listed for cardiac transplantation may benefit from defibrillator implantation regardless of an established indication[J].J Heart Lung Transplant,2003,22(4):411-418.
[19]	Ermis C,Zadeii G,Zhu AX,et al.Improved survival of cardiac transplantation candidates with implantable cardioverter defibrillator therapy:role of beta-blocker or amiodarone treatment[J].J Cardiovasc Electrophysiol,2003,14(6):578-583.
[20]	Bilchick KC,Kamath S,DiMarco JP,et al.Bundle-branch block morphology and other predictors of outcome after cardiac resynchronization therapy in Medicare patients[J].Circulation,2010,122(20):2022-2030.
[21]	Wells G,Parkash R,Healey JS,et al.Cardiac resynchronization therapy:a meta-analysis of randomized controlled trials[J].CMAJ,2011,183(4):421-429.