扩张型心肌病患者心脏再同步化治疗术后早期及远期随访

Comparison of the early postoperative period and long-term follow-up of patients with dilated cardiomyopathy after cardiac resynchronization therapy

目的分析扩张型心肌病心力衰竭(简称心衰)患者心脏再同步治疗(CRT)的早期与远期疗效。方法回顾性分析在本院成功植入CRT的扩张型心肌病患者。所有患者术前行12导联心电图,超声心动图,组织多普勒,NYHA心功能分级及心衰生存答卷,并于术后1周及不少于12个月的最终随访时复查。结果共有34例完成随访,随访28.55±17.31个月,无死亡病例,仅2例再同步治疗后仍反复出现心衰并因此再入院治疗。术后1周内NYHA心功能分级、6 min步行距离、心电图QRS波时限、左室舒张末径、射血分数、左室内不同步均有明显改善。最终随访上述指标进一步改善。QRS波时限<160 ms者术后1周有改善,最终随访进一步改善;QRS波时限≥160 ms者早期改善不明显,但最终随访时仍有改善。结论 CRT对扩张型心肌病患者的治疗作用早期即显现出来,远期效果仍进一步提高。

Objective To evaluate the short-term and long-term effectiveness of cardiac resynchronization therapy （CRT） in patients with dilated cardiomyopathy （DCM）. Methods Retrospective analysis of the hospital successfully implanted CRT in patients with DCM. All patients underwent 12 lead electrocardiogram, echocardiography, tissue Doppler, NYHA grading of heart function and heart failure survival respondents, as well as 1 week after operation and the final fol- low-up review. Results A total of 34 patients completed a follow-up of 28.55 ＋ 17.31 months, no death case, only 2 cases relapsed after resynehronized therapy and thus rehospitalized. In this group of patients within 1 weeks after operations, NYHA heart function classification, 6 minutes walking distance, ECG QRS wave duration, left ventricular end diastolic di- ameter, ejection fraction, left intraventricular dyssynchrony showed significant improvement. At the final of follow-up, NY- HA heart function classification, 6 minutes walking distance, left intraventricular dyssynchrony had further improved. Conclusions CRT on DCM patients with early stage show obvoious improventment of heart function, long-term effect still keeps further improvement. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2013,27 （3） ：222-2241