双心室再同步治疗后无应答发生率及原因分析

Incidence and causes of nonresponse to cardiac resynchronization therapy in patients with congestive heart failure

目的 观察本中心双心室再同步治疗（CRT）术后无应答的发生率,并分析可能导致无应答的原因.方法 2001年3月至2009年5月119例患者行CRT治疗（男96例,年龄34～82岁）,NYHA心功能Ⅲ～Ⅳ级,左心室射血分数≤35%,随访6个月以上.结果 119例患者中,7例在CRT置人后6个月内因不同原因死亡,112例完成6个月以上的随访,无应答发生率为28.57%.多因素logistic回归分析提示心力衰竭病程、肺动脉高压、血清肌酐值增高、完全性右束支传导阻滞及心室电极导线置人位置均是CRT无应答的独立危险因素.在CRT术后6个月时,CRT应答组心力衰竭的常规治疗药物明显减少,主要是洋地黄和利尿剂与无应答组比较差异有统计学意义（P＜0.01＝.结论 CRT术后无应答的发生率为28.57%.完全性右束支传导阻滞虽然也有QRS时限明显增宽,但CRT术后无应答的发生率明显增高.左心室电极导线的位置是决定CRT术后无应答发生的重要环节,心大静脉不宜做左心室电极导线置入的部位.

Objective To observe the incidence and explore the potential factors of nonresponse to cardiac resynchronization therapy （CRT） in patients with severe chronic congestive heart failure. Method CRT was performed in 119 patients with NYHA function class Ⅲ - Ⅳ and left ventricular ejection fraction ≤35% [96 men and 23 women, age （60.5 ± 11.3 ） years ]. Results Seven patients died for different reasons between 1 - 6 months post CRT and clinical and echocardiographic （Echo） data at 6 months post CRT were analyzed from the remaining 112 patients. The incidence of nonresponse to CRT was 28.57%.Compared to the response group, complete right bundle branch block, longer course of congestive heart failure, higher pulmonary systolic pressure and serum creatinine level and non-optimal target vessels positioning of the left venticle lead（ the great cardiac vein and the middle cardiac vein）were the independent predictors for nonresponse after CRT（ all P 〈 0.05）. Compared with nonresponse group, the dosages of digoxin and diuretics used for heart failure were significantly reduced in response group （ P 〈 0.01 ）.Conclusions The incidence of nonresponse after CRT was 28.57% in this patient cohort Higher pulmonary systolic pressure and serum creatinine level and non-optimal target vessels positioning of the left venticle lead （ the great cardiac vein and the middle cardiac vein） were the independent predictors for nonresponse after CRT.