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背景虽然目前植入型心脏复律除颤器(ICD)已经越来越多地应用到严重心衰患者(心功能III/IV级)中,但是其应用受到泵衰竭容易引起死亡以及数据较少的限制。本研究的目的是评估QRS波群宽度和疾病病因对植入ICD的严重心衰患者生存率和再入院率的影响。方法纳入了1996—2000年间出院的438例心衰患者(年龄56±15岁,心脏射血分数29%±15%,76%患者的心脏分级为III/IV级)进行回顾性研究。结果438例患者中有94例因非持续性(51.1%)或持续性室性心动过速(24.4%)、晕厥(16.0%)或出于预防目的(8.5%)植入了ICD。所有植入ICD患者的基线平均射血分数较低(25%vs30%,P=0.007),但符合心功能IV级症状的患者比例并不高(33%vs44%,P=0.164)。结果发现,植入ICD的患者具有较高的生存率(RR0.48,P=0.001),但其再入院率也较高(RR1.41,P=0.031)。在缺血性和非缺血性亚组分析中,植入ICD患者的生存率具有明显的优势(RR0.38,P=0.003;RR0.54,P=0.042)。QRS<120ms并植入ICD的患者具有生存率较高的趋势(RR0.42,P=0.119),但其再入院率也升高(RR2.13,P=0.021)。QRS≥120ms并植入ICD的患者具有较高的生存率(RR0.45,P=0.001),而再入院率不升高(RR1.22,P=0.314)。结论严重心衰患者植入ICD可以比未植入患者获得更高的生存率,但是其再住院率也升高。而且该治疗对QRS波群宽度延长患者的益处更明显。
Background Although implantable cardioverter defibrillators (ICDs) have been increasingly used in patients with severe heart failure (cardiac function III / IV), their use is likely to result in death from pump failure and less data limits. The purpose of this study was to assess the impact of QRS complex width and disease etiology on survival and readmission rates in patients with severe heart failure who have ICD implants. METHODS: We retrospectively reviewed 438 patients with heart failure (56 ± 15 years of age, 29% ± 15% of cardiac ejection fraction, and 76% of patients with cardiac grade III / IV) who were discharged from hospital between 1996 and 2000. Results Of the 438 patients, 94 were ICD implanted due to non-sustained (51.1%) or persistent ventricular tachycardia (24.4%), syncope (16.0%) or for preventive purposes (8.5%). The baseline mean ejection fraction was lower in all ICD patients (25% vs 30%, P = 0.007), but the proportion of patients who met Grade IV symptoms was not high (33% vs 44%, P = 0.164). The results showed that ICD patients had a higher survival rate (RR 0.48, P = 0.001), but also higher rehospitalization rates (RR 1.41, P = 0.031). In ischemic and non-ischemic subgroup analyzes, survival was significantly higher in ICD-implanted patients (RR 0.38, P = 0.003; RR 0.54, P = 0.042). Patients with QRS <120 ms and ICD implanted had a higher survival rate (RR 0.42, P = 0.119) but also increased readmission rates (RR 2.13, P = 0.021). Patients with QRS≥120ms and ICD implantation had a higher survival rate (RR0.45, P = 0.001), while readmission rates did not increase (RR1.22, P = 0.314). Conclusions The ICD implantation in patients with severe heart failure can achieve higher survival rate than those without implantation, but the rehospitalization rate also increases. And the benefits of this treatment on patients with a prolonged QRS complex width are even more pronounced.