应用左心室舒张末容积校正的QRS持续时间对心脏同步化治疗的预测作用

Prediction for cardiac resynchronization therapy by normalization of QRS duration to left ventricular end-diastolic volume

目的探究左心室舒张末容积校正的QRS持续时间(QRSd/LVEDV)对心脏同步化治疗的预测作用。方法2010年1月至2019年1月于解放军总医院选择接受心脏同步化治疗(CRT)的慢性心力衰竭患者79例,在手术前1个月内和术后1年分别进行了心电图和超声心动图检查QRSd和左心室舒张末容积(LVEDV),对上述资料进行单因素及多因素Logistic回归分析。结果CRT应答组患者的QRSd/LVEDV显著高于CRT无应答组[(0.73±0.27)ms/ml比(0.58±0.21)ms/ml,P=0.043];而两组患者的QRSd和LVEDV差异无统计学意义。合并左束支传导阻滞(LBBB)的患者,QRSd/LVEDV与心功能变化显著相关(R=0.469,P=0.032),而在非LBBB患者中,QRSd/LVEDV与心功能变化无显著相关。ROC曲线分析显示,QRSd/LVEDV是CRT应答的重要预测因子(AUC=0.79,P=0.006);多因素回归分析显示,QRSd/LVEDV、LBBB和非缺血性心肌病是CRT应答的独立预测因子。结论QRSd/LVEDV是心力衰竭患者CRT术后应答的独立预测因子。

Objective To explore the predictive effect of normalized QRS duration(QRSd/LVEDV)of left ventricular end-diastolic volume correction on cardiac synchronized therapy(CRT).Methods Seventy-nine patients with chronic heart failure who received CRT were selected.The QRSd and left ventricular end-diastolic volume(LVEDV)were examined by electrocardiography and echocardiography within 1 month before surgery and 1 year after surgery.Results The QRSd/LVEDV of patients in CRT response group was significantly higher than that of CRT non-response group[(0.73±0.27)ms/ml vs.(0.58±0.21)ms/ml,P=0.043],while there was no statistical difference between QRSd and LVEDV in the two groups.In the patients with LBBB,QRSd/LVEDV was significantly associated with changes in cardiac function(R=0.469,P=0.032),while in non-LBBB patients,QRSd/LVEDV was not significantly associated with changes in cardiac function.ROC curve analysis showed that QRSd/LVEDV was an important predictor of CRT response(AUC=0.79,P=0.006);multivariate regression analysis showed that QRSd/LVEDV,LBBB and non-ischemic cardiomyopathy were the independent predictors of CRT response.Conclusion QRSd/LVEDV is an independent predictor of postoperative CRT response in patients with heart failure.