心脏再同步治疗在窄QRS波慢性心力衰竭患者的疗效观察

Clinical observation of cardiac resynchronization therapy for chronic heart failure patients with narrow QRS complexes

目的:观察窄QRS波慢性心力衰竭(CHF)患者的双心室再同步治疗的临床疗效。方法:筛选16例窄QRS波CHF患者行双心室再同步治疗,所有病例均经冠状静脉窦植入左心室导线至心脏静脉,术后平均随访1～43个月,平均13个月,观察心功能、左心室射血分数、二尖瓣反流面积、左心室舒张末和收缩末内径等的变化。结果:16例患者治疗后心功能明显改善,有效率75%,心功能从Ⅲ～Ⅳ级(NYHA分级)改善为Ⅱ～Ⅲ级,左心室射血分数从(0.31±0.11)%提高至(0.38±0.10)%,P<0.05,每搏输出量从(74±8)ml提高至(96±4)ml,P<0.05,二尖瓣反流面积从(8±4)cm2减少至(6±3)cm2,P<0.05,左心室舒张末内径、收缩末内径虽有缩小趋势但没有显著差异[(69±7)mmvs.(68±9)mm;(59±10)mmvs.(56±11)mm]。结论:双心室再同步治疗对某些窄QRS波CHF患者同样有效。

AIM： To investigate the clinical effect of cardiac resynchronization therapy for chronic heart failure patients with narrow QRS complexes. METHODS： Sixteen chronic heart failure patients with nanow QRS complexes received cardiac resynchronization therapy with left ventricle lead implanted into appropriate cardiac coronary vein. RESULTS： Cardiac function of 16 individuals was significantly improved after treatment. NYHA class of the patients improved from class Ⅲ - Ⅳ to class Ⅱ -Ⅲ. After treatment, left ventricular ejection fraction （LVEF） significantly increased [ （0.31 ± 0. 11 ） % vs. （0. 38 ± 0. 10） % , P 〈 0.05 ] and the cardiac stroke volume （SV） also significantly increased [ （74 ± 8 ） ml vs. （96 ± 4） ml, P 〈 0. 05 ]. Mitral regurgitation （MR） significantly diminished （ 8 ± 4） cm2 vs. （6 ±3 ） 2 cm , P 〈0. 05 ] and left ventricular end diastolic diameter （LVEDD） and left systolic diameter （LVESD） decreased （69±7） mm vs. （68 ± 9） mm, （59± 10） mm vs. （56±11 ） ram, P 〉 0. 05]. CONCUSION： These results suggest that cardiac resynchronization therapy is effective for some chronic heart failure patients with narrow QRS complexes.