心脏再同步化治疗心力衰竭患者左室起搏位点与临床获益的研究

The study of left ventricular pacing site and clinical benefit in heart failure patients with cardiac resynchronization therapy

目的分析心脏再同步化治疗（CRT）心力衰竭（心衰）患者不同左室起搏位点与临床获益的关系。方法 收集52例CRT-P/D（起搏/除颤）植入患者临床资料，据左室电极植入部位分为前壁组（10例）、侧壁组（15例）、后壁组（16例）和后基底部组（11例），使用明尼苏达生活质量评分、左室功能和重构指标评价CRT疗效。结果 除前壁组外，其余各组明尼苏达生活质量评分术后均较术前降低（P〈0.05）。前壁组和后基底部组术后3个月左室舒张末内径（LVEDD）与术前比较差异无统计学意义（P〉0.05），其余各组均较术前减低（P〈0.05）。术后3个月仅后壁组左室射血分数（LVEF）较术前增加（P〈0.05）；前壁组仅在术后12个月时较术前增加（P〈0.05）；其余各组均在术后6和12个月时较术前增加（P〈0.05）。前壁组CRT无反应率明显高于其余各组（P〈0.05）；侧壁、后壁、后基底部组CRT应答比率明显高于前壁组（P〈0.05），侧壁、后壁和后基底部组组间比较，差异无统计学意义（P〉0.05）。侧壁、后壁和后基底部组术后3个月△QRSd均高于前壁组（P〈0.05）；后基底部组△QRSd低于侧壁和后壁组（P〈0.05）。结论 左室电极植入侧壁和后壁的患者术后反应性优于后基底部，应尽量避免将左室电极植入前壁。

Objective To investigate the relationship between different left ventricular pacing sites and clinical benefit in heart failure patients treated with cardiac resynchronization therapy （CRT）. Methods Clinical data of 52 patients of CRT-P/D （pacing and defibrillation） implantation were collected. According to the left ventricular lead implantation sites, 52 cases were divided into anterior wall （10 cases） , lateral wall （15 cases） , posterior wall （16 cases） , and posterior base group （11 cases）. The efficacy of CRT was evaluated by Minnesota life quality score, left ventricular function and remodeling index. Results In addition to the anterior wall group, Minnesota life quality score of the other groups were significantly lower than preoperative group （ P 〈 0. 05）. Compared to pre-CRT implantation, left ventricular end diastolic diameter （LVEDD） of the anterior wall and posterior basal group 3 months after CRT implantation had no statistical significance （ P 〉 0. 05 ） ; the rest groups were lower than preoperative group （ P 〈 0. 05 ）. Left ventricular ejection fraction （LVEF） in posterior wall group was increased after CRT implantation 3 months compared to the preoperative group （ P 〈 0. 05）. LVEF in anterior wall group was increased only in the 12 months after CRT implantation （ P 〈 0. 05）. LVEF in the rest groups was increased comparing to the preo- peration at 6 and 12 months postoperation （ P 〈0. 05）. CRT non-response rate in anterior wall group was significantly higher than that in the other groups （ P 〈 0. 05）. CRT response ratio was significantly increased in side, posterior and posterior basal wall compared to the anterior Wall group （ P 〈 0. 05 ）. And there were no statistical significance among side wall, posterior wall and basal wall group （ P 〉 0. 05）. A QRSd was higher in side wall, posterior wall and posterior basal group after CRT implantation 3 months than anterior wall group （ P 〈 0. 05）, A QRSd in posterior basal group was lower than the other two groups （ P 〈 0. 05 ）. Conclusions Left ventricular electrode should be implanted at the side wall and posterior wall firstly, secondly at the posterior basal wall, and avoid at the anterior wall of the left ventricle.