慢性心力衰竭患者植入心肌收缩力调节器8例临床分析

Clinical analysis of eight patients with chronic heart failure implanted with cardiac contractility modulation

目的:探讨心肌收缩力调节器(CCM)对慢性心力衰竭的临床疗效。方法:回顾性分析2022年5月—2023年5月在苏州大学附属第一医院心内科植入CCM的8例慢性心力衰竭患者的临床资料,比较其术前与术后6个月左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心房内径(LAD)、肺动脉压收缩压(PASP)、NYHA心功能分级的差异,同时观察患者的临床症状变化。结果:与术前相比,患者植入CCM 6个月后的所有观察指标均有所改善:LVEF从术前的(25.6±4.7)%提高至(35.6±5.6)%(t=-7.5,P<0.05);LVEDD从(70.0±2.4) mm降至(65.1±3.9) mm(t=4.2,P<0.05);LAD从(53.0±6.2) mm降至(48.4±7.0) mm(t=2.1,P>0.05),PASP从[27.0(19.5,37.8)]mmHg降至[23.5(19.8,26.8)]mmHg(1 mmHg=0.133 kPa,Z=-1.7,P>0.05)。所有患者都达到了NYHA心功能Ⅱ级,胸闷、气喘等症状均得到明显改善。结论:CCM可有效提高慢性心力衰竭患者的LVEF并逆转心室重构。

Objective To explore the clinical efficacy of cardiac contractility modulation (CCM) in patients with chronic heart failure.Methods This study retrospectively analyzed the clinical data of eight patients with chronic heart failure who underwent CCM implantation in the Department of Cardiology, The First Affiliated Hospital of Soochow University from May 2022 to May 2023.The differences in left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), left atrium diameter (LAD), pulmonary artery systolic pressure (PASP), and NYHA functional classification before and after 6 months of treatment were compared to observe changes in clinical symptoms.Results Compared to pre-implantation, all observed indicators of patients improved six months after CCM implantation: LVEF increased from (25.6 ± 4.7)% to (35.6 ± 5.6)%(t=-7.5, P < 0.05), LVEDD decreased from (70.0 ± 2.4) mm to (65.1±3.9) mm (t=4.2, P < 0.05), LAD decreased from (53.0 ± 6.2) mm to (48.4 ± 7.0) mm (t=2.1, P>0.05), and PASP decreased from[27.0(19.5, 37.8)]mmHg to[23.5(19.8, 26.8)]mmHg (Z=-1.7, P>0.05).All patients reached NYHA functional classification Ⅱ.Symptoms such as chest tightness and dyspnea showed significant improvement.Conclusion CCM effectively improves the left ventricular ejection fraction in patients with chronic heart failure and reverses ventricular remodeling.