顽固性心力衰竭心脏再同步化治疗远期疗效研究

Long-term effectiveness of cardiac resynchronization therapy for refractory heart failure

目的评价心脏再同步化治疗(CRT)对顽固性心力衰竭的长期疗效及生存预后的影响。方法18例顽固心力衰竭患者入选为CRT组,另选与之各项临床特征相比均无显著性差异的18例为对照组。所有患者均有CRT的适应证。CRT组施行右心房双心室或单纯双心室起搏并动态随访、优化起搏参数,同时两组患者皆给予正规的抗心力衰竭药物治疗。结果CRT组患者平均随访1～48(24.7±12.4)月,对照组平均随访1～38(20.9±10.5)月。CRT组辅以常规药物治疗,因心力衰竭住院事件减少,因心力衰竭死亡率下降,临床症状改善,心功能提高,运动耐量增加,生活质量提高,心脏重塑进程延缓,所有指标变化与对照组差异均有显著性意义。结论与单纯药物治疗相比,CRT结合药物治疗更可使某些顽固性心力衰竭患者在以上多方面受益。合理用药、动态随访和个体化参数优化是保证起搏系统稳定发挥CRT功能和患者充分受益的关键。

Objective To evaluate long-term effectiveness of cardiac resynchronization therapy（CRT） for refractory heart failure and it＇s influence on prognosis. Methods Thirty-six consecutive patients with refractory heart failure were eligible for CRT and enrolled in the study. Of them, 18 cases received CRT and medical therapy （CRT group） and another 18 cases only received medical therapy （control group）. The baseline clinical parameters considered in the study were similar in both groups. Biventricular pacing or biventricular and right atrial pacing was performed and pacing parameters were optimized individually in CRT group. Results The follow-up duration was 1-48 （24.7 ± 12.4） months in CRT group and 1-38（20.9± 10. 5 ） month in control group. Numbers of hospitalization and mortality due to heart failure reduced, clinical symptoms and quality of life improved, heart function and exercise capacity increased, and ventricular remodeling retarded in CRT group. There were significant differences between two groups. Conclusion CRT plus medical therapy may be benefit to some patients with refractory heart failure. Pacing parameters optimization combined with rational medication is the key to successful CRT.