J. Erath, Nikolett Vigh, B. Muk, Carsten W. Israel, Sarah Keck, D. Pilecky, G. Duray, M. Vámos
{"title":"洋地黄疗法对大型多中心队列 CRT 受试者的临床影响","authors":"J. Erath, Nikolett Vigh, B. Muk, Carsten W. Israel, Sarah Keck, D. Pilecky, G. Duray, M. Vámos","doi":"10.3390/jcdd11060173","DOIUrl":null,"url":null,"abstract":"(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months ± 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all p ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88–1.5; p = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75–1.45; p = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72–1.70; p = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA p < 0.01; LVEF p < 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock (p = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40–0.85; p = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up.","PeriodicalId":502527,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"22 2","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients\",\"authors\":\"J. Erath, Nikolett Vigh, B. Muk, Carsten W. Israel, Sarah Keck, D. Pilecky, G. Duray, M. Vámos\",\"doi\":\"10.3390/jcdd11060173\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months ± 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all p ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88–1.5; p = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75–1.45; p = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72–1.70; p = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA p < 0.01; LVEF p < 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock (p = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40–0.85; p = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up.\",\"PeriodicalId\":502527,\"journal\":{\"name\":\"Journal of Cardiovascular Development and Disease\",\"volume\":\"22 2\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-06-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiovascular Development and Disease\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3390/jcdd11060173\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Development and Disease","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3390/jcdd11060173","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
(1) 引言:在严重心力衰竭患者中使用洋地黄存在争议。我们在一项针对心脏再同步化疗法(CRT)接受者的大型观察性研究中评估了洋地黄治疗对死亡率的影响。(2)方法:在欧洲三家三级转诊中心接受 CRT 除颤器治疗的连续患者被纳入研究,平均随访 37 个月(± 28 个月)。在植入 CRT 时对洋地黄的使用情况进行了评估。采用多变量 Cox 回归模型和倾向得分匹配来确定主要终点全因死亡率。CRT反应(定义为NYHA分级改善≥1级)、超声心动图改善(定义为LVEF改善≥5%)以及ICD电击和再住院发生率作为次要终点,在患者亚群中进行评估。(3)结果:该研究包括552名具有标准适应症的CRT受试者,其中219名患者(40%)接受了洋地黄治疗。与未使用洋地黄的患者相比,他们更常见心房颤动,LVEF较差,NYHA分级较高(所有P均≤0.002)。对全因死亡率的粗略分析表明,使用和未使用洋地黄的患者的相对死亡风险相似(HR = 1.14;95% CI 0.88-1.5;P = 0.40)。对独立的死亡预测因素进行调整后,洋地黄治疗并未改变死亡风险(调整后 HR = 1.04;95% CI 0.75-1.45;p = 0.82)。此外,与 286 名倾向分数匹配的患者相比,洋地黄摄入量对死亡率也没有影响(倾向调整 HR = 1.11;95% CI 0.72-1.70;p = 0.64)。未使用洋地黄的患者主要出现 CRT 反应,HF 症状和 LVEF 均有所改善(NYHA p < 0.01;LVEF p < 0.01),而使用洋地黄的患者更常出现室性心动过速,需要 ICD 电击(p = 0.01);不过,与未使用洋地黄的患者相比,使用洋地黄的患者因心脏原因再入院的比例明显降低(HR = 0.58;95% C. I. 0.40-0.85;p = 0.01)。(4)结论:洋地黄治疗对死亡率没有影响,但会降低对 CRT 的反应,并增加需要 ICD 电击治疗的室性心律失常的易感性。尽管如此,洋地黄类药物能积极改变随访期间心脏再住院的可能性。
Clinical Impact of Digitalis Therapy in a Large Multicenter Cohort of CRT-Recipients
(1) Introduction: Digitalis use in patients with severe heart failure is controversial. We assessed the effects of digitalis therapy on mortality in a large, observational study in recipients of cardiac resynchronization therapy (CRT). (2) Methods: Consecutive patients receiving a CRT-defibrillator in three European tertiary referral centers were enrolled and followed-up for a mean 37 months ± 28 months. Digitalis use was assessed at the time of CRT implantation. A multivariate Cox-regression model and propensity score matching were used to determine all-cause mortality as the primary endpoint. CRT-response (defined as improvement of ≥1 NYHA class), echocardiographic improvement (defined as improvement of LVEF of ≥ 5%) and incidence of ICD shocks and rehospitalization were assessed as secondary endpoints in a subgroup of patients. (3) Results: The study comprised 552 CRT-recipients with standard indications, including 219 patients (40%) treated with digitalis. Compared to patients without digitalis, they had more often atrial fibrillation, poorer LVEF and a higher NYHA class (all p ≤ 0.002). Crude analysis of all-cause mortality demonstrated a similar relative risk of death for patients with and without digitalis (HR = 1.14; 95% CI 0.88–1.5; p = 0.40). After adjustment for independent predictors of mortality, digitalis therapy did not alter the risk for death (adjusted HR = 1.04; 95% CI 0.75–1.45; p = 0.82). Furthermore, in comparison to 286 propensity-score-matched patients, mortality was not affected by digitalis intake (propensity-adjusted HR = 1.11; 95% CI 0.72–1.70; p = 0.64). A CRT-response was predominant in digitalis non-users, concerning both improvement of HF symptoms and LVEF (NYHA p < 0.01; LVEF p < 0.01), while patients on digitalis had more often ventricular tachyarrhythmias requiring ICD shock (p = 0.01); although, rehospitalization for cardiac reasons was significantly lower among digitalis users compared to digitalis non-users (HR = 0.58; 95% C. I. 0.40–0.85; p = 0.01). (4) Conclusions: Digitalis therapy had no effect on mortality, but was associated with a reduced response to CRT and increased susceptibility to ventricular arrhythmias requiring ICD shock treatment. Although, digitalis administration positively altered the likelihood for cardiac rehospitalization during follow-up.