双心室起搏逆转心脏结构重塑的临床观察

The Clinical Study of Biventricular Pacing Reversing Cardiac Remodeling in Heart Failure.

观察双心室同步起搏治疗慢性充血性心力衰竭 (简称心衰 )逆转心脏结构重塑的中远期疗效并探讨其可能机制。4例扩张性心肌病中晚期患者 ,心功能NYHA分级Ⅲ级 2例、Ⅳ级 2例 ,均伴有心室内阻滞。其中 3例置入三腔双心室起搏器、1例为四腔起搏。术后对心功能、二维超声心动图、动态心电图、心脏远达正侧位片等进行了 12～ 2 0个月的随访。所有双心室起搏器均一次性安置成功。随访资料显示 4例患者各房室内径 ,心胸比率缩小 ;心脏搏出量、左室射血分数等显著提高 ;二尖瓣返流、QRS波时限减少 ,NYHA分级提高到Ⅰ～Ⅱ级 ,6min步行距离明显增加。心脏结构重塑时间发生在术后 6个月内 ,以后结构趋于稳定。 4例中 1例猝死 ,无一例因严重心衰而住院或死亡。结论 :双心室起搏能逆转慢性心衰患者的心脏结构重塑 ,明显改善心功能 ,提高生活质量。

To observe the effect of reverse cardiac structure remodeling in patients with chronic congestive heart failure(CHF) by biventricular pacing and its underlying mechanisms,four patients with NYHA class Ⅲ to Ⅳ heart failure,left ventricle ejection fraction(LVEF)≤0.35,and electrocardiographic QRS wave complex duration>140 ms were recruited.All patients received biventricular pacing(3 case in right atrial and biventricular pacing and 1 case in biatrial and biventricular pacing)and the effects of this therapy were assessed serially up to 12～20 months after pacing by 2D UCG,Holter,NYHA class and 6 minute hall walk distance etc.Compared with the corresponding values at baseline,there was significant improvement of LVEF,cardiac output,and 6 minute hall walk distance and decreasing in the diameter of atria and ventricle after pacing for 12～20 months.The reducing in mitral regurgitation,QRS duration and NYHA class were also observed.Conclusion:Biventricular pacing reverses heart structure remodeling and improves cardiac function in patients with CHF.