心脏再同步化起搏术后电逆重构与疗效的关系

Relationship between electric reverse remodeling and therapeutic effect after cardiac resynchronization therapy

目的评价心脏再同步化起搏(CRT)术后发生电逆重构患者对心功能和预后的影响。方法本研究回顾分析成功植入的62例CRT患者,且随访资料完整。根据术后6个月患者的自身体表心电图QRS波时限的变化分为电逆重构组(QRS波时限术后较术前缩短≥20ms,20例)和非电逆重构组(QRS波时限术后较术前缩短<20ms,42例);分析两组患者的基线特征,术后左室大小、心功能及心血管死亡率。结果电逆重构组和非电逆重构组QRS波时限平均缩短(31.0±18.6)ms和(2.62±4.45)ms,两组间有显著性差异(P<0.001);两组左室射血分数值分别提高了0.205±0.106和0.087±0.085(P<0.001);左室舒张末内径缩小分别为(11.00±6.10)mm和(6.29±6.75)mm(P=0.01);电逆重构组无患者死亡,非电逆重构组因心血管死亡10例(23.8%,P=0.02)。结论CRT术后发生电逆重构患者具有更好的心功能改善和预后。

Objective To investigate the clinical characteristics and prognosis of the patients with electric reverse remodeling(ERR)after cardiac resynchronization therapy (CRT). Methods Date of 62 CRT patients were retrospectively analyzed.The patients were divided into ERR group and non-ERR group according to the changes of QRS duration(QRSd)after CRT.The definition of ERR is QRSd decrease more than 20 ms.The non-ERR means QRSd decrease less than 20 ms.The baseline characteristics,cardiac function change and cardiovascular mortality was investigated during the follow up. Result There were significant differences in QRSd decrease between ERR and non-ERR [(31.0±18.6)ms vs (2.62±4.45)ms,P<0.001].Left ventricular ejection fraction increased 0.205±0.106 and 0.087±0.085 in ERR and non-ERR group,respectively (P<0.001).The left ventricular end diastolic diameter reduced in ERR group significantly different from non-ERR group [(11.00±6.10)mm vs (6.29±6.75)mm,P=0.01];The cardiovascular mortality between ERR and non-ERR group was significantly different (0% vs 23.8%,P=0.02). Conclusion The patients with ERR after CRT have better cardiac function improvement and prognosis.