超声心动图在心脏再同步化治疗优化中的应用研究

Study of AV optimization of cardiac resynchronization therapy by echocardiography

目的：探讨超声心动图评价和优化心脏再同步化治疗（CRT）的价值,总结超声心动图应用于CRT优化的关键指标及方法学。方法：CRT治疗1~3年患者23例,优化组（17例）设定房室间期（AVD）在80~180ms,以20 ms逐次增减,比较不同AVD下超声心动图指标的即刻差异;6例未优化患者作为对照组。对优化组和对照组优化即刻/首次检查与随访6个月时各项指标进行比较。结果：优化组最佳AVD间期分布在100~140ms,取值跨度为80~160 ms,个体差异明显;优化后获得即刻血流动力学改善：左心室舒张充盈时间（LVFT）、二尖瓣流速时间积分（VTI-Mv）、左心室收缩期压力上升速率（dp/dt）增加,二尖瓣反流口面积（MV-EROA）、心功能指数（Tei指数）降低（均P〈0.05）。优化组优化后6个月血流动力学和临床指标进一步改善：Tei指数和纽约心功能分级（NYHA）分级降低,dp/dt和6min步行试验增加,与优化即刻比较,均P〈0.05;对照组6个月后仅Tei指数优于首次检查（P〈0.05）,其他指标均差异无统计学意义（P〉0.05）。结论：超声心动图指导CRT优化可使CRT患者获得即刻和长期的血流动力学和临床状态改善,该方法有可能成为改进CRT疗法的重要手段,有良好应用前景。

Objective： To explore the value of evaluating and optimizing to cardiac resynchronization therapy （CRT） by echocardiography, and find out the key parameters of echocardiography used in optimizing cardiac resynchronization therapy and its methodology. Method： The study subjects consists of 23 inpatients in the duration of CRT 1-3 years. Patients were divided randomly into two groups, the optimized atrioventricular delay （AVD） group （n= 17） and non-optimized AVD group （n= 6） as control. AV delay optimization was firstly programmed at 80 ms, 100 ms, 120 ms, 140 ms, 160 ms and 180 ms, comparing the immediate difference of the echocardio- graphic parameters measured at all AV intervals, and the optimzed was set. 6 mouths later, the echocardiographic and clinical parameters of the two group patients were follown up and compared intragroups. Result： In optimized group ,the optimzed AV delay ranged from 100 ms to140 ms. the individual variability ranging from 80 160 ms is considerably obvious. The optimized AV delay parameters improved immediately, LVFT, VTI-M v, VTI-Av and dp/ dt increased, and MV-EROA and Tel index decreased （P〈0.05）. In optimized group, following up 6 months of AV delay post-optimization was associated with a further improvement , decrease in Tel index, and NYHA classification and improvement in dp/dt 6 rain walk test （each P〈0.05） compared immediate of AV delay post-optimization. In the group as control,only the Tei index was improved （P〈0.05）, the ether parameter differencs didn＇t have any sense （P〉0.05）. Conelusion：CRT patients performed optimization of AV delays under the supervision of echocardiography obtained immediate and chronic improvement of hemodynamic and clinical parameters. It is useful to optimize CRT system dynamically, and may become a important meaning that improve CRT treatment and have a good future.