19例慢性心力衰竭患者心脏再同步化治疗术后应答反应的临床观察分析

Clinical observation and analysis of response after cardiac resynchronization therapy in 19 patients with chronic heart failure

目的探讨慢性心衰心脏再同步化治疗应答分布情况。方法对2007年11月-2017年11月我院收治的19例慢性心力衰竭患者采用心脏再同步化治疗的临床资料进行回顾性分析,长期追踪患者生存情况,分析心脏再同步化治疗的可能预测因子及目前存在的问题。结果19例患者中,10例患者CRT应答,8例患者CRT无应答,1例患者失访;应答组及无应答组基线红细胞分布宽度2组差异有统计学意义(Z=-2.981,P=0.003);而QRS波时限、肾小球滤过率、年龄、心率、血压、BMI、左室射血分数、左房内径、左室舒张末内径、右室内径、左室短轴缩短率、室间隔、左室后壁、心室舒张容量及心室收缩容量、胱抑素c、尿素、尿酸、白蛋白均无差异;心脏再同步化治疗前后,患者QRS波时限、心功能NYHA分级、左室射血分数、左室射血分数、左室短轴缩短率、左室舒张容量、左室收缩容量差异均存在统计学意义(P<0.05),而左室舒张末内径、左房内径、右室内径、心输出量则无明显变化。结论心脏再同步化治疗能够逆转患者心电及机械重塑,是慢性心衰非药物治疗的首选方法。基线红细胞宽度的增加显示心脏再同步化治疗无应答,可作为慢性心衰患者心脏再同步化治疗的预后评估因子。

Objective To investigate the distribution of response to cardiac resynchronization therapy in patients with chronic heart failure. Methods Retrospective analysis was used for hospital medical records of 19 patients with chronic heart failure of cardiac resynchronization therapy in our hospital from November 2007 to November 2017. Long-term follow-up of patients’ survival were taken, to analyze the possible predictors of cardiac resynchronization therapy and current problem. Results Of the 19 patients, 10 had CRT response, 8 had no response to CRT, and 1 was lost to follow-up. There was a statistically difference in the distribution of baseline red blood cell width between the response group and the non-responder group(Z=-2.981,P=0.003),and there were no significant differences in baseline QRS duration, glomerular filtration rate, age, heart rate, blood pressure, BMI, left ventricular ejection fraction, left atrial diameter, left ventricular end-diastolic diameter, right ventricular diameter, left ventricular short axis shortening rate, ventricular septum, left ventricular posterior wall, ventricular diastolic volume and ventricular systolic volume, cystatin c, urea acid and albumin.After treatment, there were differences in QRS duration, NYHA classification of cardiac function, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular short axis shortening rate, left ventricular diastolic capacity and left ventricular systolic capacity(P<0.05), while there were no significant changes in left ventricular end-diastolic diameter, left atrial diameter, right ventricular diameter and cardiac output. Conclusion Cardiac resynchronization therapy can reverse the patient’s electric and mechanical remodeling, and it is the preferred method for non-pharmacological treatment of chronic heart failure. An increase in baseline red blood cell width indicates no response to cardiac resynchronization therapy and can be used as a prognostic factor for cardiac resynchronization therapy in patients with chronic heart failure.