心脏再同步化联合美托洛尔缓释片治疗老年扩张型心肌病心力衰竭的临床观察

Outcome of cardiac resynchronization therapy combined with metoprolol tartrate sustained-release tablets in senior patients with drug-refractory heart failure in dilated cardiomyopathy

目的观察心脏再同步化(cardiac resynchronization therapy,CRT)联合美托洛尔缓释片治疗老年扩张型心肌病顽固性心力衰竭的疗效。方法回顾性分析2010年6月至2012年3月绍兴第二医院,药物治疗效果不佳行右心房加CRT的老年扩张型心肌病顽固性心力衰竭患者21例的临床资料。18例患者植入右心房、右心室和冠状静脉左心室分支电极导线,行房室顺序CRT;3例心房颤动患者植入右心室和冠状静脉左心室分支电极导线。所有患者均服用美托洛尔缓释片,剂量(62.45±18.25)mg。术后4周、12周跟踪随访患者,观察心功能分级、6 min步行距离的变化、左心室舒张末期内径,左心室射血分数及二尖瓣反流。结果右心房、右心室和左心室导线感知和起搏参数均符合起搏要求,随访中亦未发现导线移位和功能障碍。起搏后QRS间期明显缩短,差异有统计学意义[(126±18)ms vs.(156±23)ms,P<0.05]。术后随访4周心功能分级提高到Ⅱ～Ⅲ级,左心室舒张末期内径为(62.5±17.6)mm,射血分数40%±13%,二尖瓣中度反流,6 min步行距离(486±189)m;12周时随访左心室舒张末期内径(56.5±12.4)mm,射血分数46%±17%,二尖瓣轻中度反流,6 min步行距离(565±139)m。结论CRT联合美托洛尔缓释片治疗可以缓解老年扩张型心肌病顽固性心力衰竭患者的症状,改善心功能,提高运动耐量,减轻二尖瓣反流。

Objectives To study the outcome of cardiac resynchronization therapy （CRT） combined with metoprolol tartrate sustained-release tablets in senior patients with drug-refractory heart failure in dilated cardiomyopathy through retrospective analysis. Methods This retrospective study comprised a total of 21 senior patients with drug-refractory heart failure in dilated cardiomyopathy in The Second Hospital of Shaoxing from June 2010 to March 2012. They were performed surgery in the fight atrium plus CRT after getting no good effect from drug therapy. Branch electrode cables were implanted in right atrium, right ventricle and vena coronaria left ventricle in 18 patients; branch electrode cables were also implanted in right ventricle and vena coronaria left ventricle in 3 patients with atrial fibrillation. All the patients took metoprolol tartrate sustained-release tablets with a dose of （62.45±18.25）mg. New York Heart Association （NYHA） functional class, 6-minute hall walk, left ventricular end-diastolic dimension （LVEDD）, left ventricular ejection fraction （LVEF）, mitral regurgitation （MR） were obsevered 4 weeks and 12 weeks after operation. Results Acute pacing and sensing thresholds measured during the implanting procedure were normal and were still effective without delocalization. QRS duration significantly shortened after biventrieular pacing in comparison with baseline [ （ 126± 18） ms vs. （ 156±23 ） ms, P〈O.05]. At 4-week follow-up, NYHA functional class raised to grade I1 -III, LVEDD was （62.5±17.6） ram, LVEF was 40%±13%, MR was midrange,6-minute hall walk was （486±189） m. At 12-week follow-up, LVEDD was （56.5±12.4） ram, LVEF was 46%±17%, MR was midrange, 6-minute hall walk was （565±139）m. Conclusions CRT combined with metoprolol tartrate sustained-release tablets in senior patients with drug-refractory heart failure in dilated cardiomyopathy can improve hemodynamies, heart function, exercise tolerance and symptoms.