冠状动脉介入治疗缺血性心肌病顽固性心力衰竭

Percutaneous coronary intervention in patients with refractory heart failure secondary to ischemic cardiomyopathy

目的评价经皮冠状动脉介入治疗(PCI)对缺血性心肌病顽固性心力衰竭的安全性及有效性。方法经冠状动脉造影证实为缺血性心肌病的顽固性心力衰竭患者,在进行了规范化药物治疗后行PCI治疗,至少完成部分血运重建。对比PCI术前及术后3个月超声心动图检查左室射血分数(LVEF)、左室舒张末内径(LVEDD)、X线心胸比例、NY-HA心功能分级及6 min步行距离,以评价PCI对患者心功能的影响。结果 26例缺血性心肌病顽固性心力衰竭患者均经PCI完成血运重建。与术前相比,患者临床症状明显减轻,NYHA心功能分级改善2级,6 min步行距离明显增加[(125±36)m vs(385±68)m,P<0.01],LVEF明显提高[(32.5±8.8)%vs(49.4±8.6)%,P<0.01],LVEDD明显缩小[(64±18)mm vs(61±16)mm,P<0.05],X线心胸比例明显缩小(0.69±0.15 vs 0.60±0.13,P<0.05)。未出现严重并发症。结论 PCI可以明显改善缺血性心肌病顽固性心力衰竭患者的心功能,提高其生活质量,近期效果好。PCI时应选择合理的血运重建策略,掌握恰当的操作方法,以确保手术安全有效。

Objective To evaluate the efficacy and safety of percutaneous coronary intervention（PCI）in patients with refractory heart failure（RHF）secondary to ischemic cardiomyopathy（ICM）.Methods For patients sufferring from ischemic cardiomyopathy confirmed by coronary artery angiography with refractory heart failure,PCI were carried out after standard drug therapy,completed at least part of revascularization.To evaluate the influence of PCI on cardiac function,left ventricular ejection fraction（LVEF）,left ventricular end-diastolic diameter（LVEDD）,X-ray cardiothoracic ratio,NYHA classification heart function and 6 min walking distance were contrasted PCI preoperative and postoperative three months.Results Reascularization by PCI were successful in all the 26 cases of ICM with RHF.Compared with preoperation,all the patients relieved obviously,the patients＇ NYHA classification cardiae function were improved by 2 levels,6 min walking distance increased obviously from（125±36）m to（385±68）m（P0.01）,LVEF increased from（32.5±8.8）% to（49.4±8.6）%（P0.01）,LVEDD decreased obviously from（64±18）mm to（61±16）mm（P0.05）,X-ray cardiothoracic ratio decreased from 0.69±0.15 to 0.60±0.13（P0.05）.And there was no svere complication.Conclusion PCI can significantly improve cardiae function and quality of life in patients with refractory heart failure secondary to ischemic cardiomyopathy.The short-term effect is good.To ensure safety and effectiveness,the reasonable reascularization strategy should be chosen and the right operation method should be grasped in the process.