心脏再同步化治疗后右心室收缩及舒张功能的早期变化

The Early Effect of Cardiac Resynchronization Therapy on Right Ventricular Systolic and Diastolic Functions in Patients With Congestive Heart Failure

目的:应用超声评价充血性心力衰竭(心衰)患者心脏再同步化治疗(CRT)后右心室收缩及舒张功能的早期变化。方法:因慢性充血性心衰行CRT治疗的患者44例,在术前、术后1周及术后6个月行超声心动图检查。测量参数包括:右心室面积变化率,三尖瓣环收缩期位移,右心室游离壁三尖瓣环收缩期运动速度(Vsr)、右心室侧壁三尖瓣环运动速度E’峰的比值(RV-E/E’)、右心室心肌做功指数等。以CRT术后6个月左心室收缩末容积减小≥15%为有应答的标准分为无应答组(n=15)与有应答组(n=29),分别比较两组CRT术前后各参数的差异。结果:无应答组与有应答组相比,术前的右心室面积变化率、三尖瓣环收缩期位移及Vsr低,RV-E/E’高,差异均有统计学意义(P均<0.05)。术后1周内,两组患者的右心室面积变化率、右心室游离壁三尖瓣环收缩期位移、Vsr、RV-E/E’及右心室心肌做功指数均有改善,与术前相比差异均有统计学意义(P均<0.05)。结论:CRT术后无论有应答组或无应答组,右心室的收缩功能及舒张功能均可得到即刻的改善。

Objective： To evaluate the early effect of cardiac resynchronization therapy （CRT） on right ventricular （RV） systolic and diastolic functions in patients with congestive heart failure （CHF） by echocardiography and tissue Doppler imaging. Methods： There were 44 consecutive CHF patients who received CRT treatment enrolled in our study. The patients underwent echo examination before CRT, and at 1 week, 6 months after CRT respectively. CRT response was defined as LV end-systolic volume decreasing≥15% at 6 months after CRT. The patients were divided into 2 groups as Non-response group, n=15, and Response group, n=29. RV function was assessed by RV fractional area change （RFAC）, tricuspid annulus plane systolic excursion （TAPSE） and velocity （Vsr）, tricuspid E/E＇, RV myocardial performance index （RV-MPI）. Results： Compare with Response group, Non-response group presented lower baseline RV systolic and diastolic functions. Within 1 week of CRT, both groups showed the early improvement in RV function as the increased RFAC and TAPSE and Vsr, and decreased RV-E/E＇ and RV-MPI, P〈0105 respectively. Conclusion： RV systolic and diastolic functions could be immediately improved in both response and non-response CHF patients.