慢性心力衰竭患者心脏再同步化治疗的疗效及其影响因素分析

Analysis of the Curative Effect and Influencing Factors of Cardiac Resynchronization Therapy in Patients with Chronic Heart Failure

目的:观察慢性心衰患者经心脏再同步化治疗(cardiac resynchronization therapy,CRT)的临床疗效,并分析CRT无应答的影响因素。方法:入选2010年1月至2015年7月上海长海医院心血管内科因心衰接受CRT的患者共47例,收集病史资料、手术资料、术后资料以及随访,比较CRT有无应答患者的临床特征,并通过多因素回归分析CRT无应答的危险因素。结果:纳入病例数共47例,其中CRT应答34例(72.3%),CRT无应答13例(27.7%)。CRT无应答组中心房颤动和冠脉问题发生率明显高于CRT应答组(P<0.05);CRT应答组中左心房容积、右心房容积、左心室容积以及二尖瓣返流量均明显低于CRT无应答组(P<0.05)。多因素回归分析显示患者合并心房颤动或冠脉问题是CRT无应答可以影响CRT的应答。结论:CRT对慢性心衰患者具有较好的疗效,而合并心房颤动或冠脉问题是预测慢性心衰患者CRT无应答的独立影响因素。

Objective： To investigate the clinical efficacy of cardiac resynchronization therapy in chronic heart failure patients and analyze the risk factors of CRT response. Methods： 47 cases of patients with chronic heart failure who accepted CRT in the Department of Cardiology from January 2010 to June 2015 in Shanghai Changhai Hospital, were retrospectively analyzed. The clinical data were collected the clinical characteristics of CRT response and non-response patients, were compared and the impact factors on CRT response were analyzed through a multiple regression analysis method. Results： Of the total 47 patients, 34 patients were CRT response（72.3 %）,13 patients were CRT non-response（27.7 %）. The occurrence rate of atrial fibrillation（P=0.037） and coronary problem（P=0.016） were higher in CRT non-response group than that those of the CRT response group. The left atrial volume（P=0.009）, right atrial volume（0.024）, left ventricular volume（P=0.024） and mitral valve reverse flow（P=0.041） in CRT response group is were obviously less than those of the CRT non-response group. Multivariate regression analysis showed that coexistence of atrial fibrillation（P=0.03） or coronary problems（P=0.02） might predict the effect of CRT non-response. Conclusion： CRT had good effect on chronic heart failure, while the coexistence of atrial fibrillation or coronary problems were the influencing factors of CRT non-response.