再同步化治疗慢性心力衰竭的疗效观察及无应答原因分析

Effects of Cardiac Resynchronization Therapy in Patients with Chronic Heart Failure

目的通过对中-重度慢性心力衰竭患者置入三腔起搏器后进行随访观察,分析心脏再同步治疗(CRT)的临床疗效以及CRT无应答的原因。方法 2009年5月至2011年11月,48例心功能Ⅲ～Ⅳ级(NYHA分级)慢性心力衰竭患者进行再同步化治疗,术后随访6个月,观察CRT后临床和超声心动图指标的变化。结果 1例患者术后4月因脑梗死死亡,1例术后5月猝死。与术前比较,术后6个月患者NYHA心功能显著改善,左室射血分数显著增加;左室舒张末内径降低;二尖瓣反流量显著减少;QRS时限显著缩短。CRT无应答率29.2%。结论 CRT能显著改善中-重度慢性心力衰竭患者心功能。但部分患者对CRT无应答,左室电极未到达理想位置、未强化内科药物治疗以及AV、VV间期未优化可能是无应答的原因。

Objective To observe and evaluate the effect of the cardiac resynchronization therapy（CRT） for the patients with chronic heart failure（CHF）.Methods From MAY 2009 to Nov 2011,48 patients with chronic heart failure（CHF） in New York Heart Association（NYHA） classes III–IV were enrolled in the study.At six months,the changes of patients condition and heart function were evaluated.Results 1 patient died of cerebral infarction at 4th month,1 patient suffered from sudden death at 5th month.Compared with baseline conditions,at 6th month,patients had been improved for increasing in NHYA、 LVEF,and decreasing in LVEDD、mitral regurgitation and QRS duration.29.2% patient did not respond to CRT.Conclusion CRT resulted in significant clinical improvement in patients with moderate-to-severe heart failure.While some patients were no response to CRT.The location of the left ventricular lead,optimized pharmacotherapy and programming were proved importance to CRT response.