CRT术后QRS波时限改变对左心功能的影响

The effect of QRS wave duration changes to left ventricular function after CRT in patients with refractory congestive heart failure

目的观察顽固性充血性心力衰竭(CHF)患者心脏再同步化治疗(CRT)术后QRS波时限改变及其对左心功能的影响。方法 60例患者接受CRT术,心功能(NYHA分级)Ⅲ～Ⅳ级,左室射血分数(LVEF)11%～35%(27.15±6.35%),左室舒张末期内径(LVEDd)60～106mm(75.35±11.01mm),QRS波时限110～190ms(139.17±23.69ms)。观察术后QRS波时限改变以及对其左心功能的影响。结果术后QRS波时限从139.17±23.69ms缩短至术后124.08±16.91ms,缩短15.42±28.90ms;左心功能从术前3.5±0.5级改善为术后1周2.5±0.5级,平均改善1.0±0.5级。CRT术前QRS波时限与术后左心功能分级改善值不相关,r≈0;而CRT术前后QRS波时限缩短值与术后左心功能(NYHA分级)改善值二组数据均呈不全正相关,r=0.148。结论 CRT术后QRS波时限与心功能均有明显改善,术前QRS波时限不能预测术后心功能改善状况,而CRT术前后QRS波时限缩短值对术后左心功能(NYHA分级)改善有一定预测价值。

Objective To observe the effect of QRS wave time changes to left ventricular function after cardiac resynchronization therapy（CRT） in patients with refractory heart failure.Methods 60 patients receive CRT,cardiac function（NYHA classification） level Ⅲ～Ⅳ,left ventricular ejection fraction（LVEF） 11%～35%（27.15±6.35%）,and left ventricular end-diastolic diameter（LVEDd） 60～106mm（75.35±11.01mm）,QRS duration up to 110ms～190ms（139.17±23.69ms）.The effects of QRS wave duration changes to left ventricular function after CRT with refractory heart failure were observed.Results QRS wave durations after CRT are reduced from 139.17±23.69 to 124.08±16.91ms,shorten 15.42±28.90ms;Left ventricular function levels are improved from preoperative 3.5±0.5 to postoperative 2.5±0.5,improved 1.0±0.5.QRS wave durations before CRT and changes of left ventricular function after CRT are not related,r≈0.The differences of QRS wave duration between preopration and postopration of CRT and changes of left ventricular function after CRT have partially positive relationship,r=0.148.Conclusion QRS wave duration and changes of heart function after CRT has improved significantly,preoperative QRS waves duration cannot predict changes of heart function（NYHA classification）,the differences of QRS wave duration between preopration and postopration of CRT have some predictive values to heart function after CRT.