carehfcompanion心脏再同步化治疗临床应用COMPANION研究和CAREHF研究.ppt

Use of cardiac resynchronization therapy (CRT) in COMPANION and CARE-HF Brief history Large group of patients in need of ICDs for primary prevention New era of biventricular pacing to improve HF symptoms COMPANION and CARE-HF Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure COMPANION COMPANION Design Parallel, randomized clinical trial in 1600 patients with moderate or severe heart failure with QRS 120 ms and PR interval 150 ms (Bristow MR et al. N Engl J Med 2004; 350: 2140-2150) Patients randomized in a 1:2:2 fashion to optimal medical therapy; optimal drug therapy plus CRT; or optimal drug therapy plus CRT with an ICD (CRT-D) Results Primary end point Combination of all-cause death and all-cause hospitalizations reduced 19% in the CRT study arm and 20% in the CRT-D study arm Death from or hospitalization for HF reduced 34% in CRT group and 40% in CRT-D group Results Secondary end point CRT alone associated with a nonsignificant trend toward a 24% reduction in all-cause mortality, a secondary end point of the study CRT with a defibrillator reduced all-cause mortality 36%, a highly significant result Significant reductions This study showed in a large population of patients that resynchronization therapy improves survival and reduces hospitalization. Survival benefit limited to those with CRT and ICD CRT challenges Implanting the coronary sinus lead Difficulty involves not getting the lead in, but getting it in the right place To achieve effective resynchronization, the lead needs to be implanted in a lateral branch of the coronary sinus Requires experienced implanter Cardiac Resynchronization Heart Failure  CARE-HF CARE-HF Rationale Cardiac dyssynchrony a problem in a large number of patients with HF and left ventricular systolic dysfunction Previous studies have suggested that CRT can improve symptoms, quality of life, and exercise capacity No conclusive evidence of an effect on hospitalizations or mortality CARE-HF Desi