CRT术后极短期心功能改变与中长期反应性的相关性

Correlation of LVEF after CRT treatment for 5 days and the mid-long term responsiveness

目的通过复查心脏再同步化治疗(cardiac resynchronization therapy,CRT)术后极短期内的心脏超声,评估双心室同步起搏的效果以及与CRT术后中长期反应的相关性。方法收集行CRT-P/D,术后平均5 d内(简称术后)复查了心脏彩超、心电图、脑钠尿肽前体(pro-BNP)等相关检查,且完成起搏器门诊首次随访(随访1,平均术后2个月)和二次随访(随访2,平均术后6个月),包括心脏彩超、心电图等辅助检查的18例患者。结果 18例入选患者平均随访6个月时,4例(22%)为超反应,7例(39%)为无反应,11例(61%)为有反应(包括超反应)。CRT有反应和无反应组在性别、年龄、扩心病、心脏大小和心功能等方面均无统计学差异CRT有反应组术后左室射血分数(LVEF)与术前、随访1和随访2的LVEF均有显著差异(P<0.05或P<0.01);而无反应组以上均无统计学差异。相关分析提示术后LVEF与随访1和随访2的LVEF值显著正相关,与体质量指数(BMI)呈负相关(均P<0.05)。结论术后极短期心功能LVEF值的变化与CRT术后中长期的反应性可能相关。

AIM To evaluate whether echocardiography results, after cardiac resynchronization therapy(CRT) implantation for 5 days, can estimate the effects of biventricular pacing and correlate with mid-long term responsiveness of CRT. METHODS The present investigation evaluated 18 patients who received CRT-P/D implantation and received echocardiography(Echo), 12-leads surface electracardiogram(ECG), Pro-BNP and other evaluations before implantation and 5 days after procedure(post-implantation). Patients were seen in clinic at the first visit(visit 1, 2 months after CRT) and the second visit(visit 2, 6 months after CRT). RESULTS Among all patients, 11 were responders, including 4 super-responders, and 7 were the non-responders. There was no significant difference in sex, age, DCM, heart size, and heart function between the two groups. There was significant difference between post-EF and pre-EF/visit 1 and EF/visit 2 EF in the responder group(all P<0.05);however, there was no significant difference observed between the above parameters in the non-responder group. Correlation analysis showed that LVEF of post-implantation was positively correlated to LVEF of visit 1 and visit 2, and negatively to BMI(all P<0.05). CONCLUSION The change of post-LVEF correlated with the mid-long term CRT response.