我院心脏再同步化治疗患者临床及预后分析

Clinical and prognosis analysis on cardiac resynchronization therapy

目的回顾性分析我院接受心脏再同步化治疗(Cardiac Resynchronization Therapy,CRT)患者的临床及预后情况。方法收集2001年至2013年在我院植入CRT-P/D(起搏/除颤)的心力衰竭(心衰)患者基线及长期随访资料。根据左室功能和重构指标,将CRT应答分为无反应、有反应和超反应组,分析三组在临床及预后方面的差异。结果 CRT术后患者长期随访92例,三组分别为28,37和27例,无反应组的心房纤颤(房颤)患者比例为57.1%,明显高于有反应组及超反应组(P=0.004)。有反应组及超反应组,CRT术后的客观指标:左室射血分数(LVEF),左室舒张末内径(LVEDD),6分钟步行距离(6MWD),左室收缩末容量(LVESV)及主观指标(NYHA分级)均较术前改善(P<0.05),术后QRS时限明显缩短(P<0.05);而无反应组患者,仅NYHA分级有一定程度的提高(P<0.05),其他指标无明显变化。结论CRT-P/D可改善心衰患者的症状及预后。房颤是导致误放电、起搏比例偏低的重要因素,可能是降低术后应答的重要原因。

Objective To analyze retrospectively the clinical materials and prognosis in patients with heart failure（HF） undergone cardiac resynchronization therapy（CRT）. Methods The baseline and long-term follow-up materials were collected from HF patients with implantation of CRT-P/D（pacing/defibrillation） from 2001 to 2013. All patients were divided, according to the left ventricular function and remodeling indexes, into non-response group, response group and super-response group. The difference in clinical materials and outcomes was analyzed in 3 groups. Results There were 92 cases followed up for a long time after CRT, and 28 in non-response group, 37 in response group and 27 in super-response group. The percentage of patients with atrial fibrillation（AF） was 57.1% in non-response group, which was significantly higher than that in response group and super-response group（P=0.004）. The indexes of left ventricular ejection fraction（LVEF）, left ventricular end-diastolic inner diameter（LVEDd）, 6-minute walk test（6MWT）, left ventricular end-systolic volume（LVESV） and NYHA grading were improved（P〈0.05）, and QRS time limit was shortened significantly（P〈0.05） in response group and super-response group after CRT. In non-response group, only NYHA grading was improved（P〈0.05） and other indexes had no significant changes. Conclusion CRT-P/D can relieve the symptoms and improve prognosis. AF is an important factor of inadequate shocks and lower pacing rate, which maybe a major cause of decreased postoperation response.