心力衰竭∶非药物治疗展望_于波.ppt

成为一类适应证 目前关于CRT有益的证据均来源于严重心衰者，是否心衰并不严重者CRT同样可以逆转心室重构；NYHA II级，符合其他CRT指征患者也能接受该治疗？否则可能使轻度心衰失去了最佳治疗时间。 其亚组特分析了LBBB,结果显示，LBBB组，死亡率降低心衰死亡降低57%，总死亡降低35%，心衰实际降低63%。明显优于---。MADIT-CRT provides clinical evidence that in high risk, NYHA Class I and II patients with LBBB, early CRT-D intervention reduces the relative risk of all-cause mortality or first heart failure event by 57% when compared to ICD therapy (p 0.001). Left bundle branch block (LBBB) was not an inclusion parameter for the MADIT-CRT trial. However, a significant interaction between treatment and bundle branch block morphology was detected. Further analyses revealed that LBBB is an objective discriminator of patient benefit from CRT-D regardless of other baseline characteristics. These impressive results were based on a 35% relative reduction in the risk of all-cause mortality (p = 0.048) (43) and a 63% relative reduction in the risk of first heart failure events (p 0.001) The MADIT-CRT trial set out to determine whether CRT-D or ICD-alone was best at reducing all-cause mortality or heart-failure, whichever came first, in mildly symptomatic patients. The results clearly demonstrate a significant 34% relative reduction in the risk of all-cause mortality or heart failure for CRT-D compared with ICD-alone (p = 0.001). What’s more, this benefit is driven by a 41% reduction in risk of heart failure events (p 0.001). The benefit was similar for both ischemic and non-ischemic patients. Reduction in heart failure events did not result in a reduction in overall mortality, possibly because of the expected low annual mortality rate of 3% in each treatment group due to the fact that patients were NYHA class I or II. The MADIT-CRT trial asked whether treatment with CRT-D or ICD-alone would be most effective in reducing all cause mortality or heart failure, whichever came first, in mildly symptomatic ischemic and non-ischemic patients. The trial was stopped when it was clear that CRT-D had crossed the superiority endpoin