CRT治疗老年心力衰竭的临床效果及无反应原因分析

Clinical efficacy of CRT treatment in elderly patients with heart failure and analysis of non-response causes

目的探讨心脏再同步治疗(CRT)老年心力衰竭的效果,分析无反应原因。方法选取本院2011年10月~2013年11月的31例老年心力衰竭患者,根据CRT治疗结果分为反应组(24例)和无反应组(7例),分析心功能状况及临床指标。结果治疗有效率为77.4%。CRT后,反应组QRS波时限变窄,无反应组QRS波时限变宽。反应组的心功能分级改善,左室射血分数、6 min步行距离增加,瘢痕面积积分、透壁程度积分、体积减小,N末端脑钠肽前体降低(P<0.05)。术前左室瘢痕负荷、左室电极位置、QRS波时限是CRT治疗老年心力衰竭的影响因素。结论CRT是治疗老年心力衰竭的有效方法,可改善心功能状况,CRT治疗无反应可能与左室电极位置、合并症、心脏收缩不同步有关。

Objective To investigate efficacy of CRT treatment in elderly patients with heart failure and to analyze non-response causes.Methods 31 elderly patients with heart failure in our hospital from October 2011 to November 2013 were selected and divided into the response group and the non-response group according to the results of CRT treatmerit.Heart function,clinical indexes were analyzed.Results The treatment efficiency was 77.4%.After CRT, QRS wave duration in response group showed narrow while wide in non-response group.Classification of cardiac function in response group improved.LVEF and 6 min walking distance increased.Scar area integral,transmural extent,volume integral decreased,Nt-BNP reduced （P〈0.05）.Preopterative left ventricular scar load,left ventricular electrode position and QRS wave duration were influencing factors of CRT treatment in elderly patients with heart failure.Conclusion CRT is an effective method in the treatment of elderly patients with heart failure,which can improve cardiac function.Non-response of CRT may be associated with left ventricular electrode position,complications,cardiac dyssynchrony.