摘要
背景:心脏再同步化治疗(CRT)是治疗伴有左束支传导阻滞的心力衰竭患者的新方法,在此类患者中左室充盈模式(LVFP)异常被认为是出现症状的原因和治疗结局的预测因素。该研究旨在探讨CRT对患者舒张功能的影响以及LVFP的预测价值。方法:对65例CRT治疗患者进行历时12个月的研究。基线时按照既定的超声心动图诊断标准,有25例患者存在限制性LVFP(RFP),40例患者为非RFP。
Background: Cardiac resynchronization therapy(CRT) is an emerging treatment for heart failure patients with left bundle branch block; in these patients left ventricle filling pattern(LVFP) abnormalities are recognized as cause of symptoms and predictors of outcome. We investigated the effects of CRT on diastolic function and the prognostic value of LVFP in patients on CRT. Methods: 65 patients treated with CRT were studied over a 12 months period. At baseline, according to defined echocardiographic criteria, restrictive LVFP(RFP) was present in 25 patients, whereas 40 patients showed no-RFP. Results: After CRT, opposite changes occurred in the two groups. In no-RFP patients, early-to-atrial filling velocity ratio(E / A) increased from 0.8±0.3 to 1.0±0.6(p=0.006) and E wave deceleration time(DT) decreased from 234±83 ms to 196±51 ms(p=0.028). In 13 RFP patients, E / A decreased from 2.2±0.9 to 0.8±0.5 and DT increased from 128±43 ms to 205±52 ms(both p< 0.001), leading to reversal of RFP. In both groups, clinical, functional and echographic benefits were evident, with mortality rates of 5%(2/40) and 15%(2/13) respectively. The remaining patients showed persistence of RFP(E/A and DT unchanged), no improvement and a mortality rate of 42%(5/12)(p=0.005, versus no-RFP). Conclusions: CRT improves diastolic function, inducing also reversal of LVFP in a consistent number of RFP patients. The persistence of RFP after CRT is associated to an extremely poor prognosis.
