心脏再同步化治疗后心脏结构和功能改变的临床分析

Cardiac resynchronization therapy after cardiac structure and function changes

目的 比较心脏再同步化治疗(CRT)后心脏结构和功能的变化,以评估CRT置入对射血分数降低的慢性心力衰竭(HFrEF)患者的疗效.方法 纳入2017年1月1日至12月31于陆军军医大学第二附属医院心血管内科就诊的HFrEF患者,患者有行CRT指征且同意行CRT,并无CRT置入的相关禁忌证,入院后择期行CRT置入术.患者分别于术前、术后3个月、6个月行超声心动图检测.测定舒张期心脏各腔室大小、左心室射血分数(LVEF)和左心室短轴缩短率(LVFS)及每搏输出量(SV).二尖瓣反流、三尖瓣反流和反流压差等参照指南推荐进行,并比较不同时间点上述各参数的变化.结果 87例患者符合纳入标准,其中15例患者符合排除标准,72例患者行CRT置入术,68例成功完成CRT并纳入本研究.CRT术后心脏各腔室大小较术前均显著下降[术前后左心室舒张末内径(63.25±9.63)mm比(63.09±9.61)mm,P<0.05],LVEF、LVFS、SV较术前均显著增加[术前后EF(38.00±9.64)%比(38.39±9.57)%,P<0.05],二尖瓣反流程度、三尖瓣反流程度及三尖瓣反流压差较术前均显著降低(P<0.05).结论 CRT可显著改善伴有心脏收缩不同步的HFrEF患者的心脏结构和功能.

Obiective To investigate the role of resynchronization therapy(CRT)in cardiac function improvement in patients diagnosed as heart failure with reduced ejcction fraction(HFEF).Methods From January 1,2017 to Dcember 31,2017,HFrEF patiens admitd to the Deparment of Criovacslar Intemal Medicine,Second Afliated Hospital of Amy Medica University were erold in this study.There were no contraindctions for CRT implantation.After admission,CRT treatment was perfomed on a selective basis.The patients were examined by echocardiography before operation,3 months and 6 months post-CRT.The diastolic dimention of each chamber was measured and the left vnticuar ecio faction(LVEF)Ief venticular short axis shortening rate(LVFS)and stroke volume(SV)were clclated.The degre of mitral rgrgitatin(MR)and tricusid rgrditin(TR)were measred according to the recommendaion of Europen Assciaion of Criaoicnalr Imaging and Americen Sociey of Ecacdoron The changs of these prmeeres were ananlyzed.Results A total of 87 cases met the inclusion criteria,of which 15 cases were excluded,72 cases underwent CRT and 4 cass faied.A total of 68 cases were included in this study.After CRT,the diasoic dimension of heart chambers decresed sificnl[let venticular end disolic diameter before and afer oeration:(6325963)mm vs.(63.09.6)mm,P<0.05],LVEF[(3.00906)%6 vs.(38.3949.57)%],LVFS and sv incresed sgificnty(P<0.05)and degree of miral and ticuspid reugitin decrereed sinifcentl(P<0.05).Conclusion CRT can significantly improve cardiac structure and function in HFrEF patients with asynchronism of cardiac contraction.