轻中度心衰患者的心脏再同步治疗.ppt
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1、轻中度心衰患者的心脏再同步治疗,上海交通大学医学院附属瑞金医院 吴立群,心脏再同步治疗随机临床试验进展累计图,2005ACC公布,据此ESC指南将CRT列为I类适应症,对4500余例以上NYHA III/IV的CHF、EF130ms的患者的临床试验表明:,CRT可以增强功能状况: CRT可以限制疾病进展: CRT可以减少心衰住院: CRT可以降低死亡率(泵衰竭所致),生活质量(QOL) NYHA分级 运动耐量,逆转重构 改善心脏功能,ACC/AHA/HRS 2008指南,LVEF35% QRS波间期0.12s 窦律 NYHA分级III或动态IV 经优化的药物治疗,CRT或CRT-D的适应证:
2、I类A级,心力衰竭: NYHA 分级,NYHA 分级I-II者约为2/3,Gras D: HRS 2008,心衰分期与NYHA分级的关系: ( ACCF/AHA Heart Failure Guidelines JACC 2009;53:e1-90),A期: 有危险因素, 无症状和器质性心脏病 B期: 有器质性心脏病, 无症状或体征 C期: 有器质性心脏病伴既往或现在的HF症状 D期: 需特殊治疗的终末期心衰患者,慢性心衰按NYHA分级治疗的目的:,Adapted from ESC Guidelines for the Diagnosis and Treatment of Acute and
3、Chronic Heart Failure 2008,轻中度心衰患者CRT的RCTs:,迄今为止, 约有包含5000例症状轻微患者的RCTs CRT限制了这类患者心衰的进展,随访(月),Contak CD,MIRACLE ICD II,CARE-HF,REVERSE,REVERSE(Europe),MADIT CRT,RAFT: Tang AS, et al. Curr Opin Cardiol 2009;24(1):1-8,目的: 检验CRTICD在12月是否能: 对象:,减缓疾病的进展 逆转左室重构,NYHA分级I,II(ACC/AHA C期) EF40% QRS120ms,Randomi
4、zed Trial of Cardiac Resynchronization in Mildly Symptomizatic Heart Failure Patients and in Asymptomatic Patients With Left Ventricular Dysfunction and Previous Heart Failure symptoms (Linde C et al. JACC 2008;52:1834-43),Randomised 1:2 (US; Europe; Canada),REVERSE: Study Design,Europe: all patient
5、s CRT ON,12 Months = Main analysis,All Geographies: Follow-up 5 years,CRT OFF (OMT ICD),CRT ON (OMT ICD),All patients receive CRT or CRTD,24 Months = European Health Economics analysis,U.S., Canada: all patients CRT ON,NYHA Class II or I (previously symptomatic) In sinus rhythm QRS 120 ms LVEF 40%,
6、LVEDD 55 mm Without bradycardia With or without ICD indication On optimal medical therapy,Linde et al. Am Heart J 2006;151:288-94.,延长期,610例,191例,419例,262例,一级终点: 心衰临床复合反应: 比较CRT OFF 对CRT ON 患者心衰恶化的比率=治疗的临床益处 二级终点: 左室收缩末期容量指数=重构逆转,Randomized Trial of Cardiac Resynchronization in Mildly Symptomizatic H
7、eart Failure Patients and in Asymptomatic Patients With Left Ventricular Dysfunction and Previous Heart Failure symptoms (Linde C et al. JACC 2008;52:1834-43),40%,54%,39%,30%,16%,21%,0%,CRT OFF,CRT ON,Pre-Specified Analysis Proportion Worsened,Worsened,Unchanged,Improved,P=0.10,REVERSE主试验: 12月,40%,6
8、0%,100%,80%,20%,C Linde et Al, JACC 2008; 52: 1834-1843,12 Month Change in LVESVi,P0.0001,P=0.004,Randomized Trial of Cardiac Resynchronization in Mildly Symptomizatic Heart Failure Patients and in Asymptomatic Patients With Left Ventricular Dysfunction and Previous Heart Failure symptoms (Linde C e
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- 关 键 词:
- 中度 心衰 患者 心脏 同步 治疗
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