心脏再同步治疗晚期扩张型心肌病的临床研究

Effect of Cardiac Resynchronization Therapy on 45 Patients with Dilated Cardiomyopathy

目的探讨心脏再同步治疗(CRT)治疗扩张型心肌病(DCM)晚期慢性心力衰竭(HF)的疗效。方法 DCM晚期发生慢性HF患者植入CRT。术后观察左室射血分数(LVEF)、左室舒张末内径(LVEDD)、心电图、NT-ProBNP,评估NYHA心功能分级,6min步行试验。结果所有患者均成功地植入右房-双心室三腔起搏器,并且无术后并发症。术后随访6～12个月心功能分级、LVEF、LVEDD、房室瓣反流速、NT-ProBNP水平、QRS波宽度较术前均明显改善,差异有统计学意义(P<0.05)。结论 CRT可以改善心功能,逆转左室重构,改善生活质量。

Objective To investigate the effect of cardiac resynchronization therapy （CRT） on 45 patients with dilated cardiomyopathy （DCM）. Methods Torty- five patients with DCM were inplanted with synchronous biventricular pacemakers, All patients had NYHA class Ⅲ to Ⅳ heart failure with ejection fraction （LVEF） （ 27.8 ± 4. 9 ） % , left ventriular end - diastolic diameter （LVEDD） （68.2 ±9.4） mm, and QRS duration of （ 152. 9 ± 14. 3） m sec. the return speed of insufficiency （4. 0±0. 6） m/see, the experiment of 6 minute＇s walking （ 199.2±99.7） m. Serial assessment was performed before and after pacing. Results After a/ollow - up period of＂ 6 - 12 months, there were significant inprovements of QRS duration decreased to （ 134.4 ± 11.2） m sec, NYHA class of heall function from （3.49 ± 0. 5 ） to （ 1.8 ± 0.4）. LVEF increased from （27.8 ± 4.9） % to （37.1 ± 4. 0） % （P 〈 0. 01 ）, LVEDD decreased from （68.2±9.4） nun to （50. 7 ±7, 0） mm （P 〈 0. 01 ）. NT - proBNP decreased from （8071.4 ±3024.4） pg/ml to （558.8± 295.0） pg/ml. Conclusion CRT can reverse left ventricular remodeling and improve heart function, raise cluality of life.