心脏再同步治疗药物难治性充血性心力衰竭的长期疗效

Long-term outcome of cardiac resynchronization therapy in patients with drug-refractory heart failure

目的观察心脏再同步化治疗(CRT)对药物难治性充血性心力衰竭的长期疗效。方法13例充血性心力衰竭患者,心功能NYHAⅢ-Ⅳ级,完全左束支传导阻滞。左室射血分数(LVEF)≤35％,左室舒张末期内径(LVEDD)≥55 mm,中度以上的二尖辦反流(MR)。组织多普勒超声显像(TDI)证实存在左、右心室和左室内机械活动不同步。对上述药物治疗无效患者行CRT治疗。术后随访内容包括临床症状、心电图和心脏超声,平均随访时间15±6个月。结果(1)手术:10例为经心脏静脉植入左室电极,2例经心外膜植入左室电极,1例行右心室双部位起搏,均无并发症。(2)心功能:术后心功能改善Ⅰ-Ⅱ级。左室射血分数由术前(27．00±3．84)％增加至术后12个月时的(40．36±7．87)％(P<0．05)。(3)死亡率:因心室颤动猝死1例。(4)QRS时限:由术前(176±10．4)ms缩短为术后即刻的(148±8．4)ms(P<P．05)。(5)超声心动图:LVEDD由术前的(75．11±14．32)mm减少至术后12个月时的(64．3±18．70)mm(P<0．05),左右心室及左室内同步性能明显好转,且随着时间的延长有持续改善。结论CRT可改善患者症状,提高心功能,并使患者长期获益。

Purpose To study the long-term outcome of cardiac resynchronization therapy （CRT） in patients with drug-refractory heart failure patients. Methods All patients fulfilled the standard CRT indication with New York Heart Association （NYHA） class Ⅲ -Ⅳ, QRS duration≥130 ms, LVEDD≥55 mm and LVEF≤35%. Tissue doppler imaging （TDI） showed dissynchronization between inter-ventricles and intra-left ventricle. The width, clinical manifestation and echocardiographic outcome of CRT was evaluated in terms of QRS parameters. The duration of follow-up was （15 ± 6） months. Results The operations were successful with no complications. The left ventricular leads were inserted through heart vein in 10 cases, epicardial in 2 cases and bifocal right ventricular pacing in 1 case. The NYHA heart function was enhanced to class Ⅱ - Ⅲ and LVEF was improved from （27.00 ± 3.84） % before operation to（40.36 ± 7.87） % 12 months after CRT （P〈0.05）. One patient died due to ventricular fibrillation. The QRS duration and LVEDD were significantly decreased after CRT for 12 months[ （176±10.4） msvs （150± 9.6）ms, and （75.11±14. 32）mm vs （64.3±18.70） mm], respectively （P〈0.05）. The synchronization of inter-ventricles and intra-left ventricle was improved. Conclusions CRT can improve long-term symptoms and heart function by ameliorating synchrony in patients with progressive heart failure.