介入治疗开通慢性完全闭塞病变对心功能不全患者心功能的影响

Impact of successful chronic total occlusion revascularization by percutaneous coronary intervention on heart function of patients with heart dysfunction

目的分析经皮冠状动脉介入治疗(PCI)开通慢性完全闭塞(CTO)病变对心功能不全患者心功能的影响。方法分析沈阳军区总医院心内科自1993年6月至2007年12月连续的472例冠状动脉CTO合并心功能不全患者的临床资料。本组患者平均年龄(59.4±11.5)岁,按PCI结果分为CTO开通成功组(n=421)与CTO开通失败组(n=51)。术后6个月复查心脏超声,分析两组间心功能的差别。结果成功组与失败组分别有391(92.9%)例及46(90.2%)例患者于PCI术后(6.2±1.7)个月复查心脏超声。成功组术后左室射血分数(LVEF)明显高于术前〔(50±6)%vs(44±3)%,P<0.05〕,左室舒张末期容积指数(LVEDVI)明显低于术前〔(78±14)ml/m2vs(85±14)ml/m2,P<0.05〕。而失败组LVEF和LVEDVI术前与术后比较无明显差异〔(42±4)%vs(44±4)%,(87±14)ml/m2vs(6±15)ml/m2,P>0.05〕。另外,与失败组比较,成功组心功能NYHA分级亦有明显改善(P<0.05)。结论介入治疗开通CTO病变可使心功能不全患者的心功能明显改善。

Objective To evaluate the. impact of successful revascularization for chronic total occlusion （CTO） by percutaneous coronary intervention （PCI） on heart function of heart dysfunction patients. Methods Between June 1993 and December 2007, the clinical data of 472 consecutive patients with heart dysfunction undergoing PCI for CTO in the General Hospital of Shenyang Military Command were analyzed. The mean age was （59.4±11.5） years. The patients were divided into CTO success group （n=421） and CTO failure group （n=51） respectively according to the results of CTO revascularization by PCI. Six months after CTO revascularization by PCI, the patients underwent cardiac ultrasound examination to compare the heart function between the two groups. Results Cardiac ultrasound examination was successfully performed in 391 patients （92. 9%） in CTO success group and 46 patients （90.2%） in CTO failure group at a mean of （6. 2 ± 1.7） months after PCI procedures. In CTO success group, left ventricular ejection fraction （LVEF） was significantly increased after PCI procedures [（50±6）% vs （44±3）% ,P〈0. 05], and left ventricular end-diastolic volume index （LVEDVI） was significantly declined [（78± 14） ml/m2 vs （85±14） ml/m2, P〈0. 05]. But the LVEF and LVEDVI showed no significent change in CTO failure group [（42 ± 4）M vs （44 ± 4） %, （87± 14） ml/m2 vs （6 ±15） ml/m2 respectively, P〉0. 05]. In addition, compared with CTO failure group, most patients in CTO success group improved in NYHA stage （P 〈 0. 05）. Conclusion Successful CTO revascularization leads to the improvement of left ventricular function in heart dysfunction patients.