不同方式的心脏再同步化治疗效果比较

Comparison on effects among different modes of cardiac resynchronization therapy

目的研究左束支优化(LOT)、双心室起搏(BiV)的心脏再同步化治疗(CRT)在慢性心力衰竭合并左束支传导阻滞患者中的应用效果。方法采用单中心、前瞻性、非随机对照的研究方法,连续纳入2020年4月至2022年4月就诊于该中心符合CRT的42例心力衰竭患者作为研究对象。其中,32例采用BiV-CRT(BiV-CRT组),10例采用LOT-CRT(LOT-CRT组)。收集患者在术前、术后即时,以及术后3、6、12个月时的起搏参数、生活质量量表(SF-36)评分、6 min步行试验(6-MWT)、心电图QRS宽度(QRSd)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、纽约心功能分级(NYHA)情况,评估患者并发症和临床结果。结果LOT-CRT组起搏阈值稳定且低于BiV-CRT组(P<0.05);术后12个月,LOT-CRT组的QRSd(115.0±14.3)ms短于BiV-CRT组的(133.0±14.0)ms,6-MWT(327.0±52.8)m长于BiV-CRT组的(274.0±52.8)m,差异有统计学意义(P<0.05);术后12个月,两组LVEF、LVEDD、NYHA心功能分级、SF-36评分较植入前均有改善。LOT-CRT组心力衰竭再住院率更低。结论LOT-CRT较BiV-CRT可获得更窄的QRS波和更长的6-MWT。

Objective To investigate the application effects of cardiac resynchronization therapy(CRT)of[left bundle optimization(LOT)]and biventricular pacing(BiV)in the patients with chronic heart failure complicating left bundle branch block.Methods The single center,prospective and non-randomized controlled study method was used.Forty-two patients with heart failure meeting CRT in this center from April 2020 to April 2022 were consecutively included.Among them,32 cases adopted the BiV-CRT(BiV-CRT group)and 10 cases adopted LOT-CRT(LOT-CRT group).The pacing-making parameters,quality of life scale(SF-36)score,6-min walk test(6-MWT),ECG QRS width(QRSd),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)and New York cardiac function grade(NYHA)situation were collected before surgery,after surgery immediately and in postoperative 3,6,12 months.Their complications and clinical outcomes were evaluated.Results The pacing threshold value in the LOT-CRT group was stable and lower than that in the BiV-CRT group(P<0.05);QRSd in postoperative 12 months in the LOT-CRT group was shorter than that in the BiV-CRT group[(115.0±14.3)ms vs.(133.0±14.0)ms,P<0.05]and 6-MWT was longer than that in the BiV-CRT group[(327.0±52.8)m vs.(274.0±52.8)m,P<0.05],and the differences were statistically significant(P<0.05);LVEF,LVEDD,NYHA cardiac grade and SF-36 score in postoperative 12 months were improved compared with those before implantation.The rehospitalization rate of heart failure in the LOT-CRT group was lower.Conclusion LOT-CRT could obtain a narrower QRS wave and longer 6-MWT than BiV-CRT.