双心室再同步化治疗心力衰竭的超应答多中心研究

Analyses of super-response to cardiac resynchronization therapy in patients with congestive heartfailure： a multiple center trial

目的探讨双心室再同步化治疗（CRT）心力衰竭患者超应答反应及预测因素。方法2001年3月至2012年3月分别在白求恩国际和平医院、沈阳军区总医院、解放军二五一医院住院行CRT的心力衰竭患者190例，男145例，女45例，平均年龄（60．5±11．9）岁，其中缺血性心肌病54例，非缺血性心肌病136例，随访6个月～11年（平均58个月）。结果190例患者中10例在术后6个月内死亡，180例完成6个月以上的随访，其中超应答51例（28．33％），应答75例（41．67％），无应答29例（16．11％），负应答25例（13．89％）。超应答患者多见于非缺血性心肌病，而负应答患者多见于缺血性心肌病（P〈0．05）；负应答患者血清肌酐水平明显增高（P〈0．05）；无应答及负应答患者肺动脉压力比超应答患者平均高10mmHg（1mmHg=0．133kPa，P〈0．05）；超应答患者术前平均QRS波时限≥160ms，术后平均减少30ms，而负应答患者术前平均QRS波时限139ms，术后平均减少81115，两者差异有统计学意义（P〈0．05）。超应答患者左心室电极的位置多在心中部或心底部，而负应答患者左心室电极的位置多在心尖部，两者差异有统计学意义（P〈0．01）。结论CRT超应答与左心室电极置入的部位明显相关，超应答左心室电极的最佳部位是心脏中部和底部，QRS波时限≥160ms招府答发牛率明显增高．

Objective To evaluate the incidence of super-response and the potential predictors related to super-response after cardiac resynchronization therapy （CRT）in patients with congestive heart failure. Methods 190 patients [ 145 men and 45 women;age： （60. 48 ± 11.91） years] underwent CRT between March 2001 and March 2012 were enrolled in this multi-center trial, of which, 54 patients with ischemic cardiomyopathy and 136 patients with non-isehemic cardiomyopathy. These patients were followed up from 6 months to 11 years （mean 58 months） post CRT. Results Ten patients died within 6 months post CRT, the others were followed up for more than 6 months. At 6-month follow-up, 51 patients were identified as CRT super-responders （28.33%）, 75 patients were CRT responders （41.67%） and 29 patients were CRT non-responders （16. 11% ） , and 25 patients were CRT negative responders （13.89%）. Super-response occurred more frequently in non-ischemic cardiomyopathy patients, while non-response most commonly occurred in ischemic eardiomyopathy patients （ P 〈 0. 05 ） ; patients in the negative response group had higher serum creatinine level than other groups （ P 〈 O. 05 ） , and patients in the non-response group and negative response group had higher pulmonary artery pressure than patients in the super-response group（ P 〈 0. 05 ） ;the average QRS duration was /〉 160 ms before CRT, and the mean decrease was around 30 ms after CRT in the super-response group while the average QRS duration was 139 ms before CRT, and the mean reduction was around 8 ms after CRT in the negative response group （ P 〈 0. 05 ）. LV lead position in the super-response group was usually in the middle and base of the heart, while in the negative response group itwas more commonly located in the apex of the heart （ P 〈 0. 01 ）. Conclusions LV lead located at the middle and pre-CRT ORS duration ≥ 160 ms are associated with super-response post CRT procedure in this patient cohort.