心脏再同步化治疗与左房容积指数变化的关系研究

Relationship between cardiac resynchronization therapy and change of left atrial volume index

目的旨在评价心脏再同步化治疗(CRT)对左房结构和功能的影响。方法选择2011年6月至2013年12月在本院心内科施行CRT治疗慢性心力衰竭的患者14例,其中男8例,女6例,所有患者均接受起搏器植入、CRT优化及规范的药物治疗,并随访6个月临床与超声指标[包括治疗前后的左心室收缩末期容积指数(LVESVi)和左心室舒张末期容积指数(LVEDVi)、左房最大容积指数(iLAVmax)、心房收缩前左房容积指数(iLAVpre)及左房最小容积指数(iLAVmin)等]。LVESVi降低幅度大于10%被视为CRT治疗有反应。结果 CRT治疗反应者(71.4%)与无反应者(28.6%)具有相似的基线特征和左室容积指数,但CRT治疗有反应者iLAVmax更低(P<0.05)。CRT显著降低LVESVi(P<0.01)、LVEDVi(P<0.01)、iLAVmax(P=0.004)、iLAVpre(P=0.003)和iLAVmin(P<0.01),但与无反应者相比,治疗有反应者iLAVmax降低更显著。相关分析显示LVEDVi与iLAVmax、iLAVmin显著相关(P<0.05)。结论 CRT治疗能够显著改善iLAVpre,iLAVmax可能成为逆转左室重构的潜在预测因素。

Objective To prospectively assess the association between cardiac resynchronization therapy （CRT ）and left atrial volume .Methods Fourteen patients with chronic heart failure ,sinus rhythm and left bundle branch block were enrolled in this study and prepared for CRT implantation .Clinical and echocardiographic evaluations were performed before CRT implantation and 6 months later .Followings were parameters of the left atrial and left ventricular volume：left ventricular end-systolic volume index （LVESVi）and end-diastolic volume index（LVEDVi） ,maximal LAV index（iLAVmax） ,etc ,LAV index before atrial systole（iL-AVpre）and minimal LAV（iLAVmin） .CRT responders were defined as those whose reduction rates were more than 10% in iL-VESV in 6-month follow-up .Results Responders（71 .4% ）and non-responders（28 .6% ）had similar baseline ,clinical characteristics and pre-implantation LV volumes .However ,iLAVmax in the responders was remarkably lower than that in non-responders .CRT therapy significantly reduced LVESVi（P〈0.01） ,LVEDVi（P〈0.001） ,iLAVmax（P=0.004） ,iLAVpre（P=0.003）and iLAVpost （P〈0.01） ,but when compared with the non-responders ,iLAVmax was much lower in responders .Correlation analysis showed that there was a significant correlation of LVEDVi with iLAVmax ,iLAVpost（P〈0.05） .Conclusion CRT therapy can significant-ly improve iLAVpre and iLAVmax may be a predictor of LV reverse remodeling .