植入型心律转复除颤器在一级预防心力衰竭患者中的应用

目的 观察左心室射血分数（LVEF）≤0.35心力衰竭患者的预后,评价植入型心律转复除颤器（ICD）作为心脏性猝死（SCD）一级预防的疗效.方法 回顾性分析2007年1月1日至2009年12月31日在北京协和医院心内科住院LVEF≤0.35且否认既往心肺复苏、晕厥和持续室性心动过速（室速）或心室颤动（室颤）心力衰竭患者,收集住院期间临床资料和实验室检查数据,以电话随访为主,主要观察终点为全因死亡,次要观察终点为全因死亡或首次心脏性再住院的联合终点.使用Kaplan-Meier法进行生存分析.结果 共83例患者入选,5例（6.4％）失访,78例完成了随访,包括ICD组20例和对照组58例.经过中位21.5（2.0～41.0）个月随访,共19例（24.4％）死亡.总体1、2、3年全因死亡率分别为16.5％、26.4％、35.0％.ICD组和对照组1年死亡率分别为10.5％和18.3％ （P=0.525,Log-rank检验）,ICD组死亡率降低了42.6％；18个月死亡率分别为10.5％和24.8％（P=0.340,Logrank检验）,ICD组死亡率降低了57.7％.全因死亡或心脏性再住院联合终点事件的1、2、3年发生率分别为40.1％、56.0％、76.0％.ICD组和对照组1年联合终点事件发生率分别为26.5％和44.1％（P=0.203,Log-rank检验）,ICD组事件发生率降低了39.9％；18个月联合终点发生率分别为26.5％和54.6％（P=0.110,Log-rank检验）,ICD组事件发生率降低了51.5％.结论 LVEF≤0.35心力衰竭患者预后较差,ICD具有降低死亡率和心脏性再住院率的倾向性.需要进一步扩大样本量研究来证实.

Implantable cardioverter defibrillator for primary prevention in heart failure patients

Objective To investigate the prognosis of heart failure patients with left ventricular ejection fraction of 35 percent or less and evaluate the effectiveness of implantable cardioverter defibrillator(ICD) implantation for primary prevention.Methods Heart failure patients with left ventricular ejection fraction of 35 percent or less and without the history of resuscitation,syncope and sustained ventricular tachycardia or fibrillation admitted to the department of cardiology in Peking Union Medical College Hospital from January 1,2007 to December 31,2009 were enrolled.The majority of patients followed up by phone,others followed up according to the medical record in the last clinic visit.The primary outcome was all-cause mortality.The secondary outcome was the composite event rate of all-cause death or cardiovascular re-hospitalization.Analysis of survival was performed by Kaplan-Meier method.Results A total of 83 patients were enrolled,but 5 patients(6.4％ ) were excluded because of loss to follow-up.Therefore,a total of 78 patients composed the study patients,and were classified into two groups,ICD group ( n =20) and control group ( n =58 ).The median follow-up was 21.5 months (range 2.0 ～ 41.0months),and 19 patients(24.4％ )died during the follow-up.The 1-,2-and 3-year mortality of the all study patients were 16.5％,26.4％ and 35.0％,respectively.The 1 -year mortality of ICD and control group were 10.5％ and 18.3％ ( P=0.525,Log-rank test),respectively,with the 42.6％ reduction of mortality of ICD group.The 18-month mortality in ICD and control group were 10.5％ and 24.8％ (P=0.340,Log-rank test),respectively,with the 57.5％ reduction of mortality of ICD group.The 1-,2-and 3-year secondary outcome event rates of the all study patients were 40.1％,56.0％ and 76.0％,respectively.The 1-year secondary outcome event rates in ICD and control group were 26.5％ and 44.1％ (P=0.203,Log-rank test),respectively,with 39.3％ reduction of secondary outcome event rate of ICD group.The 18-month secondary outcome event rates in ICD and control group were 26.5％ and 54.6％ ( P =0.110,Log-rank test),respectively,with the 51.5％ reduction of the secondary outcome event rate of ICD group.Conclusions The prognosis of heart failure patients with left ventricular ejection fraction of 35 percent or less was poor.ICD implantation had the trend to reduce the mortality and the composite events rate of all-cause death or cardiovascular re-hospitalization.Further study needs to be done.