右心室功能对心脏再同步化治疗术后生存的预测价值

Prognostic effects of right ventricular dysfunction in patients receiving cardiac resynchronization therapy

目的探讨右心室功能对心脏再同步化治疗（CRT）疗效的影响及其对术后生存的预测价值。方法对162例接受CRT的心力衰竭患者的临床资料进行回顾性分析，根据术前右心室内径和三尖瓣环水平收缩位移（TAPSE）测值将其分为右心室功能正常组与右心力衰竭组。收集并比较两组术前与术后6个月的临床心功能、心电图QRS波时限、超声心动图测值等指标。以心源性死亡为主要终点事件，分析两组生存函数的差异，并通过Cox回归模型分析主要终点事件的预测因子。结果术后随访6个月，右心室功能正常组的左心室舒张末内径、左心室收缩末内径、左心室射血分数和美国纽约心脏病学会心功能分级Ⅲ级／Ⅳ级构成均显著优于右心力衰竭组（P值均〈0．05）。右心力衰竭组的60个月累积生存率为（57．4±11．7）％，显著低于右心室功能正常组的（89．3±3．6）％（P〈0．01）。多因素回归分析显示，仅右心力衰竭是心源性死亡的独立预测因子[风险比（HR）=3．804，95％CI为1．193～12．134，P=0．024]。结论右心力衰竭患者行CRT的临床疗效劣于右心功能正常患者，右心力衰竭是CRT后心源性死亡的独立预测因子。

Objective To explore the effect of right ventricular dysfunction （RVD） on clinical outcome and long-term survival in patients undergoing cardiac resynchronization therapy （CRT）. Methods A cohort of 162 patients suffering from heart failure and undergoing CRT were enrolled in this retrospective study. According to the measurements of right ventricular diameter and tricuspid annular plane systolic excursion （TAPSE）, they were divided into group A with normal right ventricular function and group B with RVD. New York heart function classification （New York Heart Association [NYHA] functional class, QRS duration and echocardiography were compared between the two groups before and 6 months after CRT. Cardiac death was taken as the primary end point. Cox regression model was used to identify factors that predicted primary end point. Results Group A showed greater improvements in echocardiographic parameters, such as left ventricular end-diastolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD）, left ventricular ejection fraction （LVEF） and NYHA functional class than group B at 6-month follow-up （all P〈0.05）. Survival rate of 60 months in group B was 57.4 % ± 11.7%, which was significantly lower than that in group A （89.3 %± 3.6 %, P〈0.01 ）. Cox regression analysis showed that only RVD served as a significant predictor of primary end point （hazard ratio [HR] = 3. 804, 95%C1： 1. 193- 12. 134, P = 0. 024）. Conclusion In patients receiving CRT, RVD is associated with an adverse long-term outcome and proves to be an independent predictor of cardiac death.