扩张型心肌病患者心脏再同步化治疗的疗效观察

Long-term outcome of cardic resynchronization therapy in the dilated cardiomyopathy patients

目的:观察在组织多普勒指导下对药物难治性扩张型心肌病(DCM)充血性心力衰竭的心脏再同步化治疗(CRT)的疗效。方法:选择18例经药物治疗后无效的DCM充血性心力衰竭患者行CRT。术前行二维超声心动图和组织多普勒检查,术后1周在组织多普勒指导下行房室和室间延迟优化。术后1个月、3个月、6个月及1年随访患者的临床症状,并比较各项参数的变化。结果:CRT后①心功能从Ⅲ～Ⅳ级改善为Ⅰ～Ⅲ级,左室射血分数由(26.42±6.7)%增加到(33.44±6.0)%,P<0.01;②左室舒张末内径由(75.31±8.52)mm减少至(67.24±10.57)mm,P<0.05;③左右室间收缩时间差、左室内不同步指数有显著改善,但随着术后时间的延长无明显变化。结论:CRT可以改善DCM患者的左、右室间和左室内收缩活动不同步,逆转心室扩大,提高心功能,其近期疗效显著。

Objective：To investigate the long-term effect of cardiac resynchronization therapy （CRT） in patients with dilated cardiomyopathy.Method：Eighteen dilated cardiomyopathy patients with drug-refractory heartfailure received cardiac resynchronous pacing. Check all the patients using the two-dimensional echocardiography and Tissue Doppler imaging（TDI） before and one week after CRT. After 1 month,3 months,6 months and one year follow-up of patients with clinical symptoms,and compare the various parameters change. Result：The NYHA heart function was improved from class Ⅲ-Ⅳ to grade Ⅰ-Ⅲ. The left ventricular ejection fraction was improved from 0.264±0.067 to 0.394±0.106 after 12 months CRT treatment （P〈0.01）. The LVEDD were significantly decreased from preoperative （75.31±8.52）mm to （67.24±10.57）mm after 12 months therapy （P〈0.05）. The Ts-SD about synchronization of inter-ventricles and intra-left ventricle was improved significantly after optimize the pacemaker parameters. Conclusion：CRT can improve the synchronization of inter-ventricles and intra-left ventricle in dilated cardiomyopathy patients,reverse ventricular enlargement,improve cardiac function,its long-term effects is significant.