PDF(Pubmed)
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.
摘要：
（1）引言：严重心力衰竭患者使用洋地黄是有争议的。我们评估了洋地黄治疗对死亡率的影响，心脏再同步治疗（CRT）受者的观察性研究。（2）方法：纳入三个欧洲三级转诊中心连续接受CRT除颤器的患者，并进行平均37个月±28个月的随访。在CRT植入时评估洋地黄的使用。使用多变量Cox回归模型和倾向评分匹配来确定全因死亡率作为主要终点。CRT反应（定义为≥1个NYHA等级的改善），在患者亚组中,将超声心动图改善(定义为LVEF改善≥5%)、ICD电击和再住院的发生率作为次要终点进行评估.（3）结果：该研究包括552名具有标准适应症的CRT接受者，其中219例（40%）接受洋地黄治疗。与没有洋地黄的患者相比，他们更经常有心房颤动，LVEF较差，NYHA等级较高（所有p≤0.002）。全因死亡率的粗略分析表明，有和没有洋地黄的患者的相对死亡风险相似（HR=1.14；95％CI0.88-1.5；p=0.40）。在调整了死亡率的独立预测因子后，洋地黄治疗并未改变死亡风险(校正后HR=1.04;95%CI0.75-1.45;p=0.82).此外，与286名倾向评分匹配的患者相比，死亡率不受洋地黄摄入量的影响(倾向校正HR=1.11;95%CI0.72-1.70;p=0.64).CRT反应在洋地黄非使用者中占主导地位，关于HF症状和LVEF的改善（NYHAp<0.01；LVEFp<0.01），而洋地黄患者更经常发生室性快速性心律失常，需要ICD休克（p=0.01）；尽管，与不使用洋地黄的人相比,使用洋地黄的人因心脏原因再住院的比例显著较低(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无影响,但与需要ICD休克治疗的患者对CRT的反应降低和室性心律失常的易感性增加相关.虽然,在随访期间，洋地黄给药积极改变了心脏再住院的可能性。
