P波指数对心脏再同步治疗效果的预测价值

Predictive value of P wave indices on cardiac resynchronization therapy

目的探讨心电图P波指数对慢性心力衰竭患者心脏再同步治疗(CRT)效果的预测价值。方法依据术前心电图P波指数(P波时限(PWD)、V1导联P波终末电势(Ptf或Morris指数)和P波时限/PR段值(Macruz指数,M))大小,将患者分为PWD1(<120ms)和PWD2(≥120ms)、Ptf1(≤-0.04mm·s)和Ptf2(>-0.04mm·s)、M1(≤1.6)和M2(>1.6)组,比较同一指标的两组患者间CRT术后6个月时的心功能指标改善及反应率有无差别。结果共117例患者资料纳入分析,结果显示:CRT术后6个月,各组患者心功能指标均有所改善,P波时限及P波终末电势不同的两组患者间相关指标改善程度差异有显著性(p<0.05),而P波时限/PR段值不同的两组患者间相关指标的改善程度并无明显差别(p>0.05),CRT反应率亦有类似发现。多因素分析显示LAD>40mm、PWD≥120ms及Ptf>-0.04mm·s与CRT反应率降低有关。结论术前心电图P波增宽及V1导联P波终末电势延长是CRT术后无反应的可能预测因子。

Objective To assess the value of P wave indices in predicting the response to cardiac resynchronization therapy（CRT）. Methods Between January 2013 and May 2014,patients received CRT/D implantation and no history of atrial fibrillation, atrial flutter, three-degree atrioventricular block, single or dual-chamber pacemaker implantation were enrolled. All patients were divided into normal P wave duration group（PW D1：120ms） and prolonged P wave duration group（PW D2：≥120ms）, or normal P wave terminal force of V_1group（Ptf1：≤-0.04mm·s） and prolonged P wave terminal force of V_1 group（Ptf2：-0.04mm·s）, or normal Macruz indices（P wave duration/PR segment） group（M1：≤1.6） and prolonged Macruz indices（P wave duration/PR segment） group（M2：1.6）. At least 5% increase in LVEF at the 6-month after CRT was defined as responders. Results A total of 117 patients were assessed. The results showed that those with prolonged P wave duration and P wave terminal force of V_1 achieved worse reverse remodeling and CRT response（p0.05）, but there was no significant difference between normal and prolonged Macruz indices group（p0.05）. In multivariable analyses, prolonged P wave duration and P wave terminal force of V_1 were emerged as powerful predictor of CRT non-response. Conclusions Prolonged P wave duration and P wave terminal force of V_1 maybe predictive factors of non-response to CRT.