心脏再同步化治疗对轻度心力衰竭患者预后影响的Meta分析

目的探讨心脏再同步化治疗(CRT)对轻度心力衰竭患者预后的影响。方法计算机检索MEDLINE、EMBASE、PubMed、Cochrane Central Register of Controlled Trials(CENTRAL)、中国生物医学文献数据库、中国期刊全文数据库、万方数据库中关于CRT、轻度心力衰竭的随机对照试验,对符合质量标准的RCT进行Meta分析。结果共检索到5篇相关文献,研究表明轻度心力衰竭经CRT治疗后,患者全因病死率的OR为0.78(95%CI 0.63～0.97,P=0.02),差异具有统计学意义(P<0.05),心力衰竭事件发生率的OR为0.62(95%CI为0.53～0.73,P<0.01),差异具有统计学意义(P<0.05),患者因心脏病再住院发生率的OR为0.67(95%CI 0.52～0.86,P=0.002),差异有统计学意义(P<0.05),运动耐量(peak VO_2)合并标准化均数差(SMD)为0.39(95%CI-0.17～0.95,P=0.17)。心室重构指数LVEDV的均数差(MD)为-36.01(95%CI-42.71～29.60,P<0.01),LVEF的MD为1.34(95%CI 0.60～2.09,P<0.01)。结论对于轻度心力衰竭患者,如果伴有QRS时限延长和明显的左心室收缩功能下降,CRT治疗后可以降低患者全因病死率,减少心力衰竭事件的发生率,减少因心脏病再住院的次数,还可明显逆转左室重构,但患者运动耐量未发现明显改善。

A Meta-analysis on prognosis of patients with mild heart failure after cardiac resynchronization therapy

Objective To investigate the cardiac resynchronization therapy（CRT） on the prognosis of patients with mild heart failure. Methods A meta-analysis of randomized controlled trials was performed with a database search of the MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials （CENTRAL）, China biological medical literature database, China journal full text database on cardiac resynchronization therapy, mild heart failure. Results 5 relevant articles were found, the result shows that there were significant differences between patients with CRT and control group on all-cause mortality OR =0.78 （95% CI 0.63 ～ O. 97, P = 0.02）, the incidence of heart failure events OR = 0.62 （95% CI 0.53～0.73, P 〈 0.01）, the incidence of hospitalization due to heart disease OR = 0.67 （95% CI 0.52 ～ 0.86, P = 0. 002） ,the peak VO2＇s SMD was 0.39（95% CI -0.17～0.95, P =0.17 ）ventricular remodeling index： the LVEDV＇s MD were - 36.01 （95% CI - 42.71 ～ 29.60, P 〈 0. 01 ）, LVEF＇s MD were 1.34 （95% CI O. 60 ～2.09, P 〈 0.01 ）, there were statistical significant differences on all of the above data （ P 〈 0.05, P 〈 0.01 ）. Conclusion For patients with mild heart failure, if accompanied by QRS duration delay and decreased left ventricular systolic function, CRT can reduce all-cause mortality, the incidence of heart failure events and the incidence of hospitalization, produce obvious left ventricular reverse reconstruction, but exercise tolerance not found obviously improved.