左束支传导阻滞伴心力衰竭患者心脏再同步化治疗无应答影响因素分析

Analysis of influencing factors of no response to cardiac resynchronization therapy in patients with left bundle branch block and heart failure

目的分析心脏再同步化治疗左束支传导阻滞(LBBB)伴心力衰竭无应答的影响因素,为临床改进LBBB伴心力衰竭患者的心脏再同步化(CRT)治疗方案提供理论依据。方法选取2013年3月至2017年12月于河南省人民医院心血管内科接受CRT治疗的21例LBBB伴心力衰竭无应答患者(研究组)和同期40例应答患者(对照组)作为研究对象,收集两组患者详细资料,进行单因素分析和独立危险因素分析。结果单因素分析结果显示QRS波时限、脑钠肽水平、左房容积、左室容积、右房容积、起搏部位、二尖瓣反流量、房颤、高血压均与CRT治疗LBBB伴心力衰竭无应答存在明显相关性(P<0.05),危险因素分析显示QRS波时限、起搏部位、二尖瓣反流量、房颤、高血压均为导致患者疗效不佳的独立危险因素(P<0.05)。结论QRS波时限、左心室电极起搏部位、二尖瓣反流量、房颤均是LBBB伴心力衰竭患者CRT治疗无应答的独立危险因素,术前优化患者选择,术中优化左室起搏部位,并结合术后起搏参数的优化控制,能够提高患者CRT治疗应答率,降低费效比。

Objective To analyze the influencing factors of no response to cardiac resynchronization therapy in patients with left bundle branch block (LBBB) and heart failure,and to provide a theoretical basis for clinical improvement of cardiac resynchronization (CRT) therapy in LBBB patients with heart failure. Methods 21 patients with LBBB who underwent CRT (Study group) in Henan Provincial People's Hospital from March 2013 to December 2017 and 40 responders (control group) in the same period were enrolled. Detailed data of two groups was collected and univariate analysis and independent risk factors analysis was conducted. Results Univariate analysis showed that QRS duration,brain natriuretic peptide level,left atrial volume,left ventricular volume,right atrial volume, pacing position,mitral regurgitation,atrial fibrillation and hypertension was significantly correlated with nonresponse of patients with LBBB and heart failure after CRT (P<0.05). Independent risk factors analysis showed that QRS duration,pacing position,mitral regurgitation,atrial fibrillation and hypertension was independent risk factors for poor curative effect (P<0.05). Conclusion QRS duration,pacing position of left ventricular electrode, mitral regurgitation and atrial fibrillation is risk factor for non-response of patients with LBBB and heart failure after CRT. Preoperative optimization of patient selection,intraoperative optimization of left ventricular pacing position, combined with optimal control of postoperative pacing parameters,can improve the response rate of CRT,reduce the cost-effectiveness ratio.