在丹麦之后,哪些病人需要植入式除颤器?

Carolina Ortiz Cortés
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引用次数: 0

摘要

三分之一的非缺血性扩张型心肌病(NIDCM)患者经历心源性猝死(SCD)。目前的指南建议在伴有症状性心力衰竭且左心室射血分数≤35%的NIDCM患者中使用植入式心律转复除颤器(ICD)。然而,尽管有明确的证据表明对缺血性病因的患者有预后益处,但在非冠状动脉病因的患者中发现的结果并不一致。丹麦研究(评估非缺血性收缩期心力衰竭患者ICDs对死亡率的影响的丹麦研究)的结果表明,ICDs不会增加NIDCM患者的生存率。迄今为止,左心室射血分数和纽约心脏协会功能分级一直是确定使用ICD进行一级预防的NIDCM患者的关键指标。今天,有新的药物可以提供更大的降低SCD的风险和替代,更具体的标记物可以更好地估计患者的风险。本文的目的是回顾和讨论在NIDCM患者中使用icd的研究,并分析经典和新出现的风险标志物的应用。最后,提出了一种个性化的SCD风险分层,以供将来使用。补充信息:本文是由诺华赞助的题为“关于心力衰竭治疗新时代的问题”的补充的一部分。
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Después del DANISH, ¿a qué pacientes indicar un desfibrilador implantable?

One third of patients with non-ischemic dilated cardiomyopathy (NIDCM) experience sudden cardiac death (SCD). Current guidelines recommend that an implantable cardioverter‐defibrillator (ICD) is used in NIDCM patients with symptomatic heart failure and a left ventricular ejection fraction ≤35%. However, although there is clear evidence of prognostic benefits in patients with an ischemic etiology, findings are not so consistent in those whose symptoms have a non-coronary origin. Results from the DANISH study (Danish Study to Assess the Efficacy of ICDs in Patients with Non-Ischemic Systolic Heart Failure on Mortality) suggest that ICDs do not increase survival in patients with NIDCM. To date, left ventricular ejection fraction and New York Heart Association functional class have been the key indicators for identifying NIDCM patients who are candidates for primary prevention using an ICD. Today, there are new drugs that could provide a greater reduction in the risk of SCD and alternative, more-specific markers that could give better risk estimates in patients. The aims of this article were to review and discuss studies on the use of ICDs in patients with NIDCM and to analyze the application of classical and newly emergent risk markers. Finally, an individualized SCD risk stratification is proposed for future use.

Supplement information: this article is part of a supplement entitled "Questions on a new era for heart failure treatment" which is sponsored by Novartis.

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来源期刊
Revista Espanola de Cardiologia Suplementos
Revista Espanola de Cardiologia Suplementos Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.20
自引率
0.00%
发文量
1
期刊介绍: Revista Española de Cardiología, is an international scientific journal dealing with cardiovascular medicine. Revista Española de Cardiología, the official publication of the Spanish Society of Cardiology, publishes research articles related to cardiovascular diseases. Articles are published in Spanish for the paper edition and in both Spanish and English in the electronic edition, which is available on the Internet. Regular sections include original articles reporting clinical or basic research, brief reports, review articles, editorials and letters to the Editor.
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