心脏再同步治疗后心室电重构和室性心律失常与左心室逆重构关系探讨

Relationship between ventricular electrical remodeling and ventricular arrhythmias and left ventricular remodeling reverse after cardiac resynchronization therapy

目的 探讨慢性心力衰竭患者心脏再同步治疗（CRT）后心室电重构和室性心律失常与左心室逆重构的关系.方法 入选因心力衰竭于我院行CRT的患者,随访术后即刻与术后6个月体表心电图与超声心动图,记录术后6个月期间窒性心律失常发作次数.根据术后6个月左心室收缩末容积缩小比例（ ΔLVESV）≥15％与否分为有效组与无效组,对比组间QRS时限变化（ΔQRSd）和室性心律失常事件,对左心室逆重构程度与ΔQRSd和室性心律失常事件进行相关性分析,寻找CRT治疗后室性心律失常的预测因素.结果 共入选43例患者,有效组29例,无效组14例,组间基线资料与术后应用药物等差异无统计学意义.全部患者CRT后6个月QRSd无变化（P=0.50）,有效组QRSd明显缩短（P＜0.01）,无效组无变化（P=0.08）.组间ΔQRSd差异有统计学意义（P=0.02）.全部患者CRT后ΔLVESV与△QRSd呈正相关（r=0.523,P＜0.01）.CRT 6个月内室性早搏（PVCs）与室性早搏连发（PVCruns）次数分析显示,log（PVCs）与log（PVC runs）在组间差异有统计学意义（P＜0.01）,log （PVCs）和log.（PVC runs）均与ΔLVESV呈正相关（P＜0.01）.多元回归分析显示,ΔLVESV是log （PVCs）的独立预测因素（β=2.36,P＜0.01）,ΔLVESV和男性是log（ PVC runs）的独立预测因素（β=2.88,P＜0.01；β=-0.74,P=0.03）.结论 CRT后左心室逆重构与电重构及室性心律失常发生减少相关.左心室逆重构程度及性别对CRT患者术后室性心律失常事件有预测意义.

Objective To investigate the relationship between reverse of left ventricular remodeling and electrical remodeling and ventricular arrhythmias after cardiac resynchronization therapy （CRT）in chronic heart failure（CHF） patients.Methods Patients with CHF scheduled for CRT were studied.Echocardiographic and Electrocardiogramic data was collected before,right after and 6 months after CRT implantation.Ventricular arrhythmia data was obtained through the pacemaker records,including premature ventricular beats（PVCs） and PVC runs.Anatomical responders were defined as those with a reduction in LVESV of at least 15% by 6 months after implantation.Change of QRS duration（ΔQRSd） and ventricular arrhythmias were compared between subgroups,and relationship between reverse of anatomic remodeling and change of QRS duration（QRSd）and ventricular arrhythmias as well as predictors of ventricular arrhythmias were assessed.Results A total of 43 patients were enrolled,including 29 as responders and 14 as nonresponders,without any baseline and medication differences between groups.All patients demonstrated no change in QRSd （P =0.50 ）.Subgroup analysis revealed obvious decreased QRSd in responders（ P〈0.01 ）,while no change in QRSd in non-responders （P=0.08）.There was a significant difference between the ΔQRSd of the two groups.In all patients reduction of LVESV was positively correlated with ΔQRSd （ r =0.523,P〈0.01 ）.Anatomic responders suffered less PVCs and PVC runs than nonresponders（ both P〈0.01 ）.Multiple regression analysis demonstrated responder status as an independent predictor of log（PVCs） （β=2.360,P〈0.01 ）,and both responder status and male gender were independently predictive of log（ PVC runs） （β=2.877,P〈0.01 and β=-0.735,P=0.034）.Conclusion Anatomic remodeling after CRT is in correlation with electrical remodeling and reduction of ventricular arrhythmias.Both remodeling of left ventricule and gender play a role in predicting ventricular arrhythmias in patients after cardiac resynchronization therapy.