心衰患者起搏器升为CRT的疗效研究

Effects of upgrading chronically right ventricle-paced heart failure pafients to cardiac resynchronization therapy

目的评价合并心力衰竭的常规起搏器患者升级为CRT逆转左室重构的作用。方法入选起搏依赖、合并心力衰竭的常规起搏器患者,将其升级为CRT。观察手术前后患者QRS时限、左室舒张末期内径(LVEDD)、射血分数(LVEF)与肺动脉收缩压(SPAP)等心脏结构和功能的变化情况。结果常规起搏器升级为CRT后,QRS时限较前明显缩短,由术前的155.2±27.1ms缩短至130±15.0ms,p<0.01。随访至术后6月,CRT有效率为68%(18/25例),LVEDD[(64.6±8.5)vs(57.56±9.5),p<0.01]显著缩小,LVEF[(29.4±3.8)vs(32.5±4.1),p<0.01]显著增加,SPAP[(46.6±12.8)vs(44.5±13.1),p<0.01]也较前下降。结论对于起搏依赖、合并心力衰竭的常规起搏器患者,升级为CRT可显著改善心功能、逆转心肌重构。

Objective To evaluate the benefit of cardiac resynehronization therapy（CRT）in patients with chronically right ventricle paced heart failure. Methods We studied patients who had a previously implanted pacemaker, They were chronically RVpaced resulted in a tremendous LV function deterioration an treated by upgrading to CRT or CRT-D. To observe the changes of the baseline character including ORS duration,and echocardiography parameters at least 6 months after upgrading to CRT or CRT-D. Result CRT significantly reduced the mean QRS duration [（155.2 ±27.1ms） vs（130 ±15.0ms）,p0.05], reduced the left ventricular end-diastolic dimensions [（64.6±8.5） vs（57.56±9.5）, p0.01] and pulmonary artery systolic pressure[（46.6±12.8） vs（44.5±13.1）,p0.01]. The LV ejection fraction[（29.4±3.8） vs（32.5±4.1）, p0.01] were increased observably, and we found that the effective rate of CRT was 68%（18/25）. Conclusion For patients with pacemaker dependent and merge heart failure in conventional pacemaker, upgraded to a reverse CRT can significantly improve cardiac function and myocardial remodeling.