实时三维超声心动图可评价并预测心脏再同步化治疗的疗效

Effects of cardiac resynchronization therapy in patients with advanced congestive heart failureevaluated by real-time 3-dimensional echocardiography

目的应用实时三维超声心动图（RT．3DE）容积时间曲线定量评价并预测心脏再同步治疗（CRT）治疗中重度心力衰竭患者的临床疗效。方法18例符合CRT适应证的慢性心力衰竭患者，其中扩张型心肌病17例，缺血性心肌病例1例，患者均拟置入双心室起搏器，进行CRT。随访8个月，观察CRT后临床症状和RT．3DE指标的变化，并对CRT的疗效进行分析。结果17例患者成功置入双心室起搏器，CRT成功率94．4％。与术前比较，纽约心功能分级平均降低1．5级（P〈0．01），左心室射血分数（LVEF）平均提高25％（P〈0．01），左心室收缩末期容积平均降低38％（P〈0．01），左心室收缩失同步指数（SDI，大于10．4％作为失同步标准）明显改善（术前平均14．2％，术后平均9．8％，P〈0．01），SDI的改变值与LVEF的改变值呈正相关（r＝0．62，P〈0．01）。CRT无应答及并发症各3例。结论CRT可改善心力衰竭患者的心功能和左心室重构。RT-3DE测定SDI的值可预测LVEF的改善情况。CRT亦存在一定的风险且部分患者无应答。

Objective To quantitatively assess the effects of cardiac resynchronization therapy （CRT） in patients with advanced congestive heart failure by real-time 3-dimensional（3D） echocardiography （RT-3DE）. Methods Eighteen patients with advanced congestive heart failure underwent CRT with New York Heart association（NYHA） class Ⅲ and 1V and wide QRS complex（ 〉 120 ms） were included （17 dilated cardiomyopathy and 1 ischemic cardiomyopathy）. Before CRT and 8 months after CRT, the clinical and RT-3DE parameters and outcome were analyzed. Results The biventricular pacemaker was successfully implanted in 17 patients （94.4%）. Compared with before CRT, NYHA class of patients decreased by 1.5 class （P 〈 0. 01 ）, left ventricular ejection fraction increased by 25% （P 〈 0. 01 ）, left ventricular end systolic volume decreased by 38% （P 〈 0. 01 ）, left ventricular systolic dyssynchrony index （SDI） improved significantly （ 14. 2% before CRT vs. 9. 8% after CRT, P 〈0. 01 ） post CRT. Change in SDI and change in LVEF was positively correlated （ r = 0. 62 ,P 〈 0. 01 ）. The procedure complications and outcome during and after CRT included coronary sinus dissection （ n = 1 ）, left ventricular lead dislodgement （ n = 1 ）, phrenic nerve stimulation （ n = 1 ）, sudden cardiac death （ n = 1 ）. Three non-response patients were complicated with atrial fibrillation, nonspecific intraventricular block and diated cardiomyopathy with postero-lateral sear tissue. Conclusions CRT could improve the cardiac function, correct the mechanical desynchronization and reverse left ＂ventricular remodeling in patients with congestive heart failure, and SDI quantification by RT-3DE could predict increase of LVEF after CRT, however, there were complications related to the implantation procedure and possibilities of non-response.