影响慢性心力衰竭患者心脏再同步化治疗效果的因素分析

Factors associated with the efficacy of cardiac resynchronization therapy in patients with chronic heart failure

目的 观察慢性心力衰竭患者心脏再同步化治疗（cardiac resynchronization therapy,CRT）的临床疗效,比较CRT有反应和无反应患者的临床特征,分析不同因素对CRT反应及预后的影响.方法 选取在浙江大学医学院附属第二医院心血管内科成功置入CRT-P/D的慢性心力衰竭患者204例,收集术前临床资料、手术资料及术后随访资料,结合手术前后临床症状及超声心动图参数的改善,评估CRT疗效.比较有反应和无反应患者的临床特征,并通过多因素回归分析及生存分析比较不同因素对CRT反应及预后的影响.结果 纳入研究者共204例,其中男性130例,女性74例,平均年龄（64.8±11.9）岁,随访6～60个月.CRT有反应者125例（61.3％）.有反应的患者中,女性、QRS波时限≥150 ms及QRS波形态呈完全性左束支传导阻滞（CLBBB）者所占比例分别为41.6％ （52/125）、58.4％（73/125）、65.6％（82/125）,明显高于CRT无反应的患者（P＜0.05）.多因素回归分析显示,QRS波时限≥150 ms是CRT有反应的唯一独立预测因子.Kaplan-Meier法分析显示CRT有反应的患者生存率高于无反应的患者（P＜0.001）.结论 临床特征,包括女性、QRS波时限≥150 ms及CLBBB,与CRT反应密切相关,其中QRS波时限≥150 ms能独立预测CRT有反应.CRT有反应的患者预后优于无反应的患者.

Objective To observe the clinical effects of cardiac resynchronization therapy （CRT）in patients with chronic heart failure,and compare the clinical characteristics and outcome between responders and non-responders to define factors related to the efficacy of CRT.Methods We retrospectively analyzed the data of patients underwent CRT-P/D implantation from January 2006 to December 2012 in our Hospital.All patients received long-term follow-up including NYHA classification,left ventricular ejection fraction （LVEF） and left ventricular internal dimension at end diastole （LVIDd）.Results A total of 204 patients were included （130 males,mean age （64.8 ± 11.9） years）.The total response rate of CRT was 61.3%.Women,QRS duration ≥150 ms,and left bundle branch block （LBBB） were related with better response after CRT （all P 〈 0.05）.Multivariate regression analysis showed that QRS duration was an independent determinant for CRT response.All-cause mortality rate was significantly lower in responder group than in non-responder group （P 〈 0.001）.Conclusions In patients with chronic heart failure,women,QRS duration ≥ 150 ms,and LBBB are related with better CRT response rate post CRT.QRS duration ≥ 150 ms is an independent predictor of CRT response,and positive response is associated with lower all-cause mortality in this oatient cohort.