CRT对扩张型和缺血性心肌病的左室机械重构疗效观察

Effect of cardiac resynchronization therapy on left ventricular remodeling in ischemic and dilated cardiomyopathy

目的观察心脏再同步化起搏治疗(CRT)对扩张型和缺血性心肌病的左室机械重构疗效差别。方法入选21例慢性充血性心力衰竭患者,分为扩张型心肌病组(13例)和缺血型心肌病组(8例)。所有患者均符合CRT指南的I类适应证。分别观察CRT术后6、12个月左室射血分数、左房内径、左室收缩内径、左室舒张内径、左室收缩末期容积、左室舒张末期容积及二尖瓣反流面积的变化。结果 (1)扩张型心肌病组CRT术后6个月,左室射血分数较术前增加,左室舒张和收缩末内径,左室舒张和收缩末容积,二尖瓣反流面积较术前减少(P<0.05),术后12个月,左室射血分数较术前增加,左室舒张和收缩末内径,左室舒张和收缩末容积,左房内径较术前减小(P<0.05);(2)缺血性心肌病组术后12个月射血分数较术前增加(P<0.05);(3)扩张型心肌病组CRT术后6个月二尖瓣反流面积的变化量大于缺血性心肌病组(P<0.05),射血分数增加量大于缺血性心肌病(P<0.05),术后12个月扩张型心肌病组左室收缩末内径、左室舒张和收缩末容积的变化量大于缺血性心肌病组(P<0.05)。结论 CRT对扩张型心肌病患者的心室逆重构效果优于缺血性心肌病患者。

Objective To investigate the effect of cardiac resynchronization therapy(CRT)on left ventricular remodeling in patients with ischemic cardiomyopathy or dilated cardiomyopathy.Methods Twenty-one patients with congestive heart failure who were all in accordance with CRT guidelines for class I indication were enrolled.There were13patients with dilated cardiomyopathy and8patients with ischemic cardiomyopathy.The left ventricular ejection fraction(LVEF),left atrium diameter(LAD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV)and the area of mitral regurgitation(MRA)were observed6and12months after CRT.Results In the dilated cardiomyopathy patients,LVEF was increased,and LVESD,LVEDD,LVEDV,LVESV and MRA were reduced6months after CRT(P<0.05);LVEF was increased while LVESD,LVEDD,LVEDV,LVESV and LAD were reduced12months after CRT(P<0.05).In the ischemic cardiomyopathy group,LVEF was increased12months after CRT(P<0.05).MRA and LVEF in the dilated cardiomyopathy group were changed more remarkably than those of the ischemic cardiomyopathy group6months after CRT(P<0.05);LVESD,LVEDV and LVESV in the dilated cardiomyopathy group were changed more remarkably than those of the ischemic cardiomyopathy group12months after CRT(P<0.05).Conclusions The effect of CRT on left ventricular remodeling in patients with dilatedardiomyopathy is much better than that in patients with ischemic cardiomyopathy.