加拿大达尔豪斯大学John L. Sapp团队研究了心力衰竭患者接受再同步除颤的长期疗效。相关论文于2024年1月17日发表在《新英格兰医学杂志》上。

再同步-除颤治疗动态心力衰竭试验（RAFT）显示，接受心脏再同步治疗（CRT）的患者在5年时的死亡率方面比接受植入式心律转复除颤器（ICD）的患者受益更大。然而，CRT对长期生存的影响尚不清楚。

研究组将患有纽约心脏协会（NYHA）II级或III级心力衰竭、左心室射血分数小于等于30%、固有QRS持续时间大于等于120毫秒（或起搏QRS持续期大于等于200毫秒）的患者随机分配为单独接受ICD或CRT除颤器（CRT-D）。他们评估了八个最高注册参与点患者的长期预后。主要结局是全因死亡；次要结局是全因死亡、心脏移植或植入心室辅助装置的综合结局。

该试验招募了1798名患者，其中1050名被纳入长期生存试验；1050名患者的中位随访时间为7.7年（四分位间距为3.9至12.8），存活患者的中位随访时间为13.9年（四分位间距为12.8至15.7）。530名ICD组患者中有405人（76.4%）死亡，520名CRT-D组患者中有370人（71.2%）死亡。接受CRT-D治疗的患者生存时间似乎比接受ICD治疗的患者更长（加速因子0.80；95%置信区间0.69至0.92；P=0.002）。ICD组412名患者（77.7%）和CRT-D组392名患者（75.4%）发生次要结局事件。

研究结果表明，在射血分数降低、QRS波群增宽和NYHA II级或III级心力衰竭的患者中，与ICD相比，接受CRT-D相关的生存益处似乎在中位随访近14年间持续存在。

附：英文原文

Title: Long-Term Outcomes of Resynchronization–Defibrillation for Heart Failure

Author: John L. Sapp, Soori Sivakumaran, Calum J. Redpath, Habib Khan, Ratika Parkash, Derek V. Exner, Jeff S. Healey, Bernard Thibault, Laurence D. Sterns, Nhat Hung N. Lam, Jaimie Manlucu, Ahmed Mokhtar, Glen Sumner, Stuart McKinlay, Shane Kimber, Blandine Mondesert, Mario Talajic, Jean Rouleau, C. Elizabeth McCarron, George Wells, Anthony S. L. Tang

Issue&Volume: 2024-01-17

Abstract:

Abstract

Background

The Resynchronization–Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter–defibrillators (ICDs). However, the effect of CRT on long-term survival is not known.

Methods

We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device.

Results

The trial enrolled 1798 patients, of whom 1050 were included in the long-term survival trial; the median duration of follow-up for the 1050 patients was 7.7 years (interquartile range, 3.9 to 12.8), and the median duration of follow-up for those who survived was 13.9 years (interquartile range, 12.8 to 15.7). Death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. The time until death appeared to be longer for those assigned to receive a CRT-D than for those assigned to receive an ICD (acceleration factor, 0.80; 95% confidence interval, 0.69 to 0.92; P=0.002). A secondary-outcome event occurred in 412 patients (77.7%) in the ICD group and in 392 (75.4%) in the CRT-D group.

Conclusions

Among patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up.

DOI: 10.1056/NEJMoa2304542

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2304542