- 作者：脫scar Fabregat-Andr茅s ; Pilar Garc铆a-Gonz谩lez ; Alfonso Valle-Mu帽oz ; Jordi Estornell-Erill ; Le ; ro P茅rez-Bosc谩 ; Victor Palanca-Gil ; Rafael Pay谩-Serrano ; Aurelio Quesada-Dorador ; Salvador Morell ; Francisco Ridocci-Soriano
- 关键词：FEVI ; fracció ; n de eyecció ; n del ventrí ; culo izquierdo ; IC ; insuficiencia cardiaca ; RM ; resonancia magné ; tica ; RTG ; realce tardí ; o de gadolinio ; TRC ; terapia de resincronizació ; n cardiaca
- 刊名：Revista Espa?ola de Cardiología
- 出版年：February, 2014
- 年：2014
- 卷：67
- 期：2
- 页码：107-113
- 全文大小：305 K
Introduction and objectives
Cardiac resynchronization therapy with a defibrillator prolongs survival and improves quality of life in advanced heart failure. Traditionally, patients with ejection fraction > 35% estimated by echocardiography have been excluded. We assessed the prognostic impact of this therapy in a group of patients with severely depressed systolic function as assessed by echocardiography but with an ejection fraction > 35% as assessed by cardiac magnetic resonance.
Methods
We analyzed consecutive patients admitted for decompensated heart failure between 2004 and 2011. The patients were in functional class II-IV, with a QRS 鈮?#xA0;120聽ms, ejection fraction 鈮?#xA0;35% estimated by echocardiography, and a cardiac magnetic resonance study. We included all patients (n = 103) who underwent device implantation for primary prevention. Ventricular arrhythmia, all-cause mortality and readmission for heart failure were considered major cardiac events. The patients were divided into 2 groups according to systolic function assessed by magnetic resonance.
Results
The 2 groups showed similar improvements in functional class and ejection fraction at 6聽months. We found a nonsignificant trend toward a higher risk of all-cause mortality in patients with systolic function 鈮?#xA0;35% at long-term follow-up. The presence of a pattern of necrosis identified patients with a worse prognosis for ventricular arrhythmias and mortality in both groups.
Conclusions
We conclude that cardiac resynchronization therapy with a defibrillator leads to a similar clinical benefit in patients with an ejection fraction 鈮?#xA0;35% or > 35% estimated by cardiac magnetic resonance. Analysis of the pattern of late gadolinium enhancement provides additional information on arrhythmic risk and long-term prognosis.
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