Echocardiographic Evaluation of Qiangxin Decoction Combined with Cardiac Resynchronization Therapy for Patients with Chronic Heart Failure

OBJECTIVE: To explore the echocardiographic evaluation of patients with chronic heart failure (CHF) after Qiangxin Decoction combined with cardiac resynchronization therapy. METHODS: A total of 140 CHF patients admitted to our hospital were randomly divided into combined group (Qiangxin Decoction and cardiac resynchronization, n = 70) and routine group (cardiac resynchronization, n = 70), and they were treated for 2 courses (16 weeks), with 8 weeks as a course. The improvement of heart function classification (HYHA) was observed before and after treatment, and the therapeutic effects were evaluated according to the improvement of heart function classification (markedly effective, effective, invalid, and worsening). The traditional Chinese medicine (TCM) diagnostic criteria was the main symptoms (0 to 6 points), secondary symptoms (0 to 3 points), tongue picture (0 to 1 point) and pulse condition (0 to 1 point), and the higher the score was, the more obvious the symptoms were. The left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF) and cardiac output (CO) were observed and recorded according to the heart color ultrasound before and after treatment. And the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to evaluate the life quality before and after treatment, and the highest score of the scale was 105 points. The higher the score was, the obvious the symptoms were, and the worse the life quality was. And the adverse reactions were recorded in the 2 groups. RESULTS: After the treatment, the total effective rate in the routine group was significantly lower than that in the combined group (75.71% vs . 94.30%), and there was statistically significant difference (P < 0.05). After the treatment, the TCM syndrome score in the routine group was higher than that in the combined group ((14.37±3.59) points vs.(10.53±3.11) points), and there was statistically significant difference (P < 0.05). After the treatment, the levels of LVEDD and LVESD in the routine group were higher than those in the combined group, and there were statistically significant differences (P < 0.05). The levels of LVEF and CO in the routine group were lower than those in the combined group, and there were statistically significant differences (P < 0.05). After the treatment, the score of MLHFQ scale in the routine group was higher than that in the combined group ((57.38±8.53) points vs.(46.39±7.14) points), and there was statistically significant difference (P < 0.05). CONCLUSION: Qiangxin Decoction combined with cardiac resynchronization therapy has good echocardiographic evaluation in patients with chronic heart failure.

Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

Objective To evaluate left univentricular （LUV） pacing for cardiac resynchronization therapy （CRT） using a rate-adaptive atrioven- tricular delay （RAAVD） algorithm to track physiological atrioventricular delay （AVD）. Methods A total of 72 patients with congestive heart failure （CHF） were randomized to RAAVD LUV pacing versus standard biventricular （BiV） pacing in a 1 ： 1 ratio. Echocardiography was used to optimize AVD for both groups. The effects of sequential BiV pacing and LUV pacing with optimized A-V （right atrio-LV） delay using an RAAVD algorithm were compared. The standard deviation （SD） of the S/R ratio in lead VI at five heart rate （HR） segments （Rs/R-SD5）, defined as the ＂tracking index,＂ was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD. Results TheQRS complex duration （132 ± 9.8 vs. 138± 10ms, P 〈 0.05）, the time required for optimization （21 ±5 vs. 50±8min, P〈 0.001）, the mitral regurgitant area （1.9 ± 1.1 vs. 2.5 ± 1.3 em2, P 〈 0.05）, the interventricular mechanical delay time （60.7 ± 13.3 ms vs. 68.3 ± 14.2 ms, P 〈 0.05）, and the average annual cost （13,200 ± 1000 vs. 21,600 ± 2000 RMB, P 〈 0.001） in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group. The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group （22.7 ± 2.2 vs. 21.4 ± 2.1 cm, P 〈 0.05）. The Rs/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group, and was significantly negatively correlated with improved left ventricular ejection fraction （LVEF） （ALVEF, Pearson＇s r = -0.427, P = 0.009）, and positively correlated with New York Heart Association class （Spearman＇s r - 0.348, P 0.037）. Conclusions RAAVD LUV pacing is as effective as standard BiV pacing, can be more physiological than standard BiV pacing, and can de- crease the average annual cost of CRT.

Cardiac resynchronization therapy improved the clinical outcomes in pacemaker patients upgraded to biventricular device

The right ventricular pacing （RVP） is the standard treat- ment for patients with severe bradyarrhythmias; however, it may cause and exacerbate heart failure symptoms in a long run under some circumstances.{1] In fact, significant left ventricular （LV） systolic dysfimction and symptomatic heart failure （HF） is commonly found in patient population with pacemaker implantations.

Cardiac resynchronization therapy in acute pulmonary edema: A case report

We are reporting a case of 71-year old lady with a dual chamber demand pacemaker,who developed acute pulmonary edema due to an acute left ventricular(LV)dysfunction and worsening in mitral valve regurgitation after atrioventricular nodal ablation for uncontrolled atrial fibrillation.This was attributed to right ventricular apical pacing leading to LV dyssynchronization.Patient dramatically improved within 12-24 h after upgrading her single chamber pacemaker to biventricular pacing.Our case demonstrates that biventricular pacing can be an effective modality of treatment of acute congestive heart failure.In particular,it can be used when it is secondary to LV dysfunction and severe mitral regurgitation attributed to significant dyssynchrony created by right ventricular pacing in patients with atrioventricular nodal ablation for chronic atrial fibrillation.

Exercise Training Post Cardiac Resynchronization Therapy Improves Exercise Tolerance and Quality of Life

Background: Cardiac resynchronization therapy (CRT) results in improved morbidity, mortality, symptoms, quality of life (QOL) and exercise capacity, in appropriate chronic heart failure (CHF) patients. Moreover, combined exercise training (ET) and CRT maximize these improvements in these patients. The study evaluated the effect of ET on these patients in terms of QOL, functional class, exercise capacity and left ventricular ejection fraction (LVEF). Results: There were significant improvements in the QOL, functional class, exercise capacity, and LVEF compared with the Control Group. Comparison of both groups confirmed the cumulative effects of ET with CRT. The QOL improved by the end of training in the exercise group (p = 0.001), compared to the Control Group (p = 0.850). NYHA functional class improved significantly in the Exercise Group (p = 0.013). Percent-predicted peak oxygen consumption (VO2 peak) had significantly improved in the trained (p < 0.001) versus the untrained CRT Group (p= 0.596). There was a mean percent rise of the ejection fraction from 39.2 ± 12.86 to 44.40% ± 14.42% in the Exercise Group compared to a non-significant change in the Control Group. Conclusion: ET in resynchronized CHF patients is feasible and further enhances QOL and exercise tolerance in addition to the improvements seen after CRT. The study therefore recommends for the prescription of ET after implantation in order to maximize the expected benefit.

Complications of cardiac resynchronization therapy in patients with congestive heart failure

Background Previous clinical studies have suggested that patients with congestive heart failure and intraventricular conduction delay could benefit from cardiac resynchronization therapy （CRT）. Implantation of left ventricular lead is a complex procedure with some potential for complications. This study was conducted to analyse the complications of CRT in patients with congestive heart failure.Methods Totally 117 patients, 86 males and 31 females, mean age of 53 years, with congestive heart failure and intraventricular conduction delaywere enrolled in this study. Venography was performed on all patients. Different types of coronary sinus leads were used to pace the left ventricle.Results Left ventricular lead was attempted to implant through coronary sinus for all the 117 patients and was successfully implanted in 111 patients. The success rate was 94.9%. Main complications rate was 6.8%, including coronary sinus dissection in 4 patients, phrenic nerve stimulation required lead repositioning in 2 patients and lead dislodgement in 2 patients.Conclusions It is feasible and safe to pace left ventricle through coronary sinus. However, there are some procedural complications.

Decrease of plasma N-terminal pro p-type natriuretic peptide as a predictor of clinical improvement after cardiac resynchronization therapy for heart failure

Background N-terminal pro β-type natriuretic peptide （NT pro BNP） has been shown to predict the prognosis and could guide the treatment of heart failure. We aimed to investigate the values of NT pro BNP in predicting the clinical response to cardiac resynchronization therapy （CRT）. Methods A total of 44 patients with chronic heart failure （34 male and 10 female, mean age of （58±13） years, New York Heart Association （NYHA） class 3.3±0.5, QRS duration （150±14） milliseconds） who underwent successful implantation of a CRT system were enrolled in this study. Pharmacotherapy remained stable during the first 3 months of follow-up. Plasma levels of NT pro BNP were evaluated before and 3 months after implantation. Clinical, echocardiographic and exercise parameters were monitored at each clinical visit after CRT implantation. Receiver operating characteristic analysis and a paired ttest were performed to analyze the data. Results After a mean of （16.3±5.5） months of follow-up, 11 nonresponders were identified. CRT resulted in a significant reduction in NT pro BNP （（1.70±1.28） vs （1.07±0.88） pmol/ml, P 〈0.001） in responders. Percentage change in NT pro BNP level （△BNP%） was a statistically significant predictor of long term clinical improvement at 3 months of follow-up. Conclusions △BNP% from baseline to 3 months of follow-up is a predictor of long term response to CRT. NT pro BNP may be a simple method for monitoring the effects of CRT.

Left ventricular 12 segmental strain imaging predicts response to cardiac resynchronization therapy

Background The number of non-responders to cardiac resynchronization therapy （CRT） exposes the need for better patient selection criteria for CRT. This study aimed to identify echocardiographic parameters that would predict the response to CRT. Methods Forty-five consecutive patients receiving CRT-D implantation for heart failure （HF） were included in this prospective study. New York Heart Association （NYHA） class, 6-minute walk distance, electrograph character, and multi echocardiographic parameters, especially in strain patterns, were measured and compared before and six months after CRT in the responder and non-responder groups. Response to CRT was defined as a decrease in left ventricular end- systolic volume （LVESV） of 15% or more at 6-month follow up. Results Twenty-two （48.9%） patients demonstrated a response to CRT at 6-month follow-up. Significant improvement in NYHA class （P 〈0.01）, left ventdcular end-diastolic volume （LVEDV） （P 〈0.01）, and 6-minute walk distance （P 〈0.01） was shown in this group. Although there was an interventricular mechanical delay determined by the difference between left and right ventricular pre-ejection intervals （（42.87±19.64） ms vs. （29.43±18.19） ms, P=0.02）, the standard deviation of time to peak myocardial strain among 12 basal, mid and apical segments （Tε-SD） （（119.97±43.32） ms vs. （86.62±36.86） ms, P=0.01） and the non-ischemic etiology （P=0.03） were significantly higher in responders than non-responders, only the Tε- SD （OR=1.02, 95% CI=1.01-1.04, P=0.02） proved to be a favorable predictor of CRT response after multivariate Logistic regression analysis. Conclusion The left ventricular 12 segmental strain imaging is a promising echocardiographic parameter for predicting CRT response.

Potential proarrhythmic effect of cardiac resynchronization therapy during perioperative period： data from a single cardiac center

Background Cardiac resynchronization therapy （CRT） could improve heart function, symptom status, quality of life and reduce hospitalization and mortality in patients with severe heart failure （HF） with optimal medical management. However,the possible adverse effects of CRT are often ignored by clinicians.Method A retrospective analysis of CRT over a 6-year period was made in a single cardiac center.Results Fifty-four patients were treated with CRT（D） device, aged （57±11） years, with left ventricular ejection fraction of （32.1±9.8）%, of which 4 （7%） developed ventricular tachycardia/ventricular fibrillation （VT/VF） or junctional tachycardia after operation. Except for one with frequent ventricular premature beat before operation, the others had no previous history of ventricular arrhythmia. Of the 4 patients, 3 had dilated cardiomyopathy and 1 had ischemic cardiomyopathy,and tachycardia occurred within 3 days after operation. Sustained, refractory VT and subsequent VF occurred in one patient, frequent nonsustained VT in two patients and nonparoxysmal atrioventricular junctional tachycardia in one patient. VT was managed by amiodarone in two patients, amiodarone together with beta-blocker in one patient, and junctional tachycardia was terminated by overdrive pacing. During over 12-month follow-up, except for one patient＇s death due to refractory heart and respiratory failure in hospital, the others remain alive and arrhythmia-free.Conclusions New-onset VT/VF or junctional tachycardia may occur in a minority of patients with or without prior history of tachycardia after biventricular pacing. Arrhythmia can be managed by conventional therapy, but may require temporary discontinuation of pacing. More observational studies should be performed to determine the potential proarrhythmic effect of CRT.

Use of the Attain Select Ⅱ catheter delivery system to improve left ventricular lead implantation in cardiac resynchronization therapy

Background Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy （CRT） devices, there are many hurdles related mainly to the variation in the anatomy of the coronary veins. One such difficulty is the presence of a very sharply-angulated or tortuous of the lateral or posterolateral cardiac vein.Methods Totally 44 patients, 28 males and 16 females, with congestive heart failure and intraventricular conduction delay were studied retrospectively. There were 23 patients who had left ventricular （LV） lead implantation using standard techniques and equipment. For the other 21 patients with LV lead implantation we used the Attain Select Ⅱ catheter delivery system. The patients were seen every 3-6 months for 12 months and the efficacy of the primary procedure, LV lead implantation time, procedure and fluoroscopy time and the complications associated with the two techniques were evaluated.Results There were no significant differences in the age, gender, New York Heart Association （NYHA） functional class,ischemic etiology, QRS duration, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and LV dyssynchrony between the two groups. The LV lead implantation time, procedure time and fluoroscopy time were significantly shorter in the group using the Attain Select Ⅱ catheter delivery system; LV lead implantation time from （51-7） minutes to （40±7） minutes （P ＜0.001）, procedure time from （143±17） minutes to （124±18）minutes （P=0.001）, and fluoroscopy time from （45±7） minutes to （35±6） minutes （P＜0.001）. A successful procedure of LV lead implantation was significantly improved from 17/23 （74%） patients using the standard techniques and equipment, to 20/21 （95.3%） patients using the Attain Select Ⅱ catheter delivery system （P=0.06）Conclusion It is feasible and safe to implant LV leads through the coronary sinus using the Attain Select Ⅱ catheter delivery system.

心脏再同步治疗对慢性心力衰竭患者心功能及心律失常的影响

目的:探讨心脏再同步化治疗对慢性心力衰竭伴左心室收缩不同步患者心功能及心律失常的影响。方法:32例慢性心力衰竭伴左心室收缩不同步的患者行CRT起搏治疗,术前心功能稳定后用心脏彩超测定左心室收缩末容积(LEVESV)、左心室舒张末容积(LVEDV)、左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、二尖瓣返流面积(MRA)、左心房面积(LAA),计算MRA/LAA比值。应用组织超声多普勒测量患者左室壁12个节段的收缩达峰时间(Ts),计算它们之间的极差(Ts-max D)和标准差(Ts-SD)。行12导联24 h动态心电图检查。术后继续抗心衰药物治疗。12周后复查上述指标进行评估。结果 :与CRT起搏器植入术前比较,术后12周LVEF、LV dp/dt较前升高,差异具有统计学意义(P<0.05),LEVESV、Ts-max D、TsSD、MRA、MRA/LAA较前下降,差异具有统计学意义(P<0.05)。LVEDV、LVEDD术前、术后比较无明显差异(P>0.05)。房性早搏及阵发性房性心动过速较术前减少,差异具有统计学意义(P<0.05),阵发性房颤、室性早搏及阵发性室性心动过速术前、术后比较差异无统计学意义(P>0.05)。结论:CRT同步化治疗可显著改善左心室收缩功能,并减少MRA及Ts,可能与CRT改善左心室同步性、减少二尖瓣返流有关,并可减少房性心律失常发生。

心肌组织速度成像对心脏再同步化治疗术后短期疗效的评价

目的应用常规超声心动图和心肌组织速度成像技术对心脏同步化治疗(CRT)的短期疗效进行评价。方法对18例心衰患者于三腔起搏器置人术前和术后1个月,应用Philips IE33分别测量左心室舒张末、收缩末的直径(LVDD、LVDS)、双平面Simpson's法测量左心室容积和射血分数(LVEF);心肌组织速度成像采集3个标准心尖切面图像,应用Q- lab分析软件测量左室基底部和中部12个节段收缩达峰时间的标准差(Ts-SD-12)及各节段心肌射血期峰值速度(Sm)、左室收缩后收缩(PSS)的峰值速度。结果心脏同步化治疗后,左室收缩同步性改善,Ts-SD-12减低,从(48.4±17.87)ms下降到(35.16±19.4)ms(P<0.05),左心室内径、容积缩小,收缩功能也有明显改善(P<0.05),各节段Sm明显提高(P<0.01)、PSS的峰值速度减低(P<0.05)。结论心肌组织速度成像技术是目前评价心肌再同步化治疗的有效手段。

心脏再同步化治疗慢性心衰的短期疗效观察

目的观察心脏再同步化治疗慢性心力衰竭(CHF)的短期临床疗效。方法26例慢性心力衰竭患者行双心室再同步起搏治疗,全部患者均经冠状静脉窦植入左心室导线1根至心脏静脉,术后随访13.8±10.4(3～34)个月,观察心功能,患者活动度及夜间心率、QRS波时限,左心室收缩、舒张末内径,左室收缩、舒张末容积,左心室射血分数,左室舒张充盈时间,左室内各室壁收缩期达峰时间等。结果26例患者中,1例于术后2个月时猝死;25例于术后3个月随访时发现心功能改善,有效率96.2%,心功能NY-HA分级,从Ⅲ-Ⅳ级改善为Ⅱ-Ⅲ级,患者活动度从0.31±0.40h/d增加至2.35±1.20h/d,夜间心率由84.8±15.7/min降低至63.4±4.5/min,心律变异性从47.3±7.1ms提高至96.4±15.1ms,QRS波从158.6±31.8ms缩短至129.5±30.2ms(P<0.05),左心室收缩末内径、舒张末内径分别从67.6±8.2mm、77.0±9.4mm缩小至62.1±12.3mm、71.6±8.7mm(P<0.05),左心室收缩末容积、舒张末容积分别从213±54ml、266±68ml缩小至151±62ml、212±63ml(P<0.05),左心室射血分数从21.2%±4.5%提高至32.5%±6.4%(P<0.05),左室舒张充盈时间从329±140ms提高至423±118ms(P<0.05),左室12个节段收缩达峰时间标准差(Ts-Sd-12)从48.4±17.9ms减少至33.5±19.7ms(P<0.05)。结论双心室再同步起搏是慢性心力衰竭治疗的有效方法。

不同QRS波形态的慢性心力衰竭患者对心脏再同步化治疗的临床反应性

目的 :探讨不同QRS波形态的慢性心力衰竭(心衰)患者对心脏再同步化治疗(CRT)的临床反应性。方法 :选取2010-03至2013-07在郑州大学第二附属医院及郑州市第七人民医院心内科接受CRT治疗的52例慢性心衰患者为研究对象。根据真性完全性左束支传导阻滞(t-CLBBB)、经典完全性左束支传导阻滞(CLBBB)和非特异性室内传导延迟(IVCD)的诊断标准,将入选患者分为t-CLBBB组(20例)、CLBBB组(15例)和IVCD组(17例)。比较3组一般临床资料、随访6个月患者的超声心动图检查[包括左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF),纽约心脏协会(NYHA)心功能分级]和6分钟步行试验(6-MWT)的变化。结果 :一般临床资料的比较:t-CLBBB组非缺血性心脏病的比例高于CLBBB组和IVCD组,差异有统计学意义(P均<0.05)。术后6个月随访结果:LVEDD和纽约心脏协会(NYHA)心功能分级在t-CLBBB组均低于CLBBB组、IVCD组[LVEDD3组分别为(62.6±8.9)mm、(70.0±8.9)mm、(72.8±8.0)mm;NYHA心功能分级3组分别为(2.00±0.45)级、(2.73±0.80)级、(3.12±0.78)级];而LVEF和6-MWT在t-CLBBB组均高于CLBBB组、IVCD组,[LVEF3组分别为(38.5±6.2)%、(31.7±6.7)%、(30.1±6.7)%;6-MWT3组分别为(302.0±57.9)m、(257.3±59.0)m、(220.2±57.9)m],3组间比较差异均有统计学意义(P均<0.05)。结论:CRT是治疗慢性心衰的一种有效的手段。不同QRS波形态的慢性心衰患者对CRT的临床疗效不同,但伴有t-CLBBB的患者对CRT有更好的反应性。

右室感知触发左室起搏心脏再同步化治疗慢性充血性心力衰竭

目的探讨右室感知触发左室起搏心脏再同步化治疗(CRT)慢性充血性心力衰竭(CHF)的效果。方法植入三腔起搏器进行心脏超声优化的CHF患者30例,分别测定传统CRT优化后及右室感知触发左室起搏CRT模式的左室射血分数(LVEF)、舒张期二尖瓣血流速度时间积分(MVI)、二尖瓣返流VTI(MR-VTI)、主动脉瓣前向血流VTI(AVI),并与CRT术前及传统CRT右室优先模式(11例)比较上述心脏超声指标、QRS波时限、优化耗时及CRT费用的差别。结果右室感知触发左室起搏模式的平均电池寿命长于传统CRT模式,QRS波时限、优化耗时及CRT年平均费用少于传统CRT模式(均P<0.01);AVI、LVEF、MVI、MR-VTI与传统CRT模式无差异(均P>0.05),但与传统CRT模式高度相关(P<0.01)。右室感知触发左室起搏模式的AVI、LVEF、MVI较右室优先模式增加,MR-VTI较右室优先模式减少(P均<0.05)。结论右室感知触发左室起搏较右室优先的传统CRT模式改善CHF患者的血流动力学,降低CRT年平均费用。

心肌做功指数与慢性心力衰竭患者心脏再同步治疗后室性心律失常的相关性研究

目的 探讨心肌做功指数（Tei指数）与慢性心力衰竭患者心脏再同步化治疗（CRT）后发生室性快速性心律失常的关系.方法 选取2009年7月至2013年10月本院心内科收治的51例行CRT的心力衰竭患者,术前行超声心动图检查并计算Tei指数,术后随访1年,起搏器程控仪分析随访期间持续性室性心动过速（VT）、心室颤动（VF）的发生次数.结果 共完成随访48例,其中无事件组33例（68.8％）,VT/VF组15例（31.2％）.两组左室射血分数（LVEF）、左房最大内径（LAD）、E峰与A峰比值（E/A）比较未见统计学差异（P＞0.05）.VT/VF组左室舒张末期内径（LVEDD）、Tei指数显著高于无事件组,差异有统计学意义（P值分别为0.034、0.013）.Tei指数与VT/VF的发生次数呈显著正相关（r=0.834,P＜0.01）,而LVEDD与VT/VF的发生次数无显著相关性（r=0.065,P＞0.05）.结论 Tei指数是慢性心力衰竭患者CRT后发生室性快速性心律失常强有力的预测因子.

左室电极起搏位置与心脏再同步化治疗的疗效

目的探讨左室电极在左室游离壁不同位置起搏对慢性心力衰竭(简称心衰)心脏再同步化治疗(CRT)患者远期疗效的影响。方法 110例扩张型心肌病或高血压病合并慢性左心衰患者均符合CRT植入指征而接受CRT术,术后根据后前位和左前斜位的胸部X线影像,左室电极导线植入部位分为前壁、侧壁、后壁和后基底部。术后12个月,分别查心脏超声、心电图等,分析心功能、心电图QRS波时限和左室射血分数(LVEF)及左室容积变化。以心功能(NYHA)分级至少改善1级或LVEF升高25%以上定义为有效。结果由于患者心脏静脉变异和组织超声多普勒检查结果,左室电极导线分别被植入前壁4例、侧壁68例和后壁37例、后基底部1例。术后3例因心功能恶化死亡,2例发生猝死,1例术后第9天因肺部感染死亡。术后12个月,104例生存者中,有效91例,无效13例,总有效率87.5%。左室电极位于侧壁组的有效率(92.4%)明显高于后壁组(85.7%)(P<0.05)。前壁或后基底部的5例均无效。结论 CRT对慢性心衰患者有效,其疗效与左室电极起搏位置密切相关,左室侧壁或后壁是左室电极导线的理想起搏部位。

心脏再同步化治疗患者自我管理现状及其影响因素

目的调查心脏再同步化治疗慢性心力衰竭患者自我管理现状并探讨其影响因素。方法对93例心脏再同步化治疗慢性心力衰竭患者,采用增加起搏器管理内容的心力衰竭自我护理指数量表进行调查,并分析其影响因素。结果患者自我管理各维度得分由高到底依次为:起搏器管理(61.17±21.34)分、自我护理维持(46.09±16.07)分、自我护理信心(39.43±27.49)、自我护理管理(30.48±17.69)分;自我效能、文化程度可以解释自我护理维持总变异的19.4%,自我效能、心功能分级可解释自我护理管理总变异的21.0%,自我效能可解释自我护理信心总变异的43.7%,自我效能可解释起搏器管理总变异的11.1%。结论心脏再同步化治疗慢性心力衰竭患者自我管理现状不理想,其中起搏器管理最好,自我护理管理最差。患者的自我效能、文化程度、心功能状况是其主要影响因素。应加强对心脏再同步化治疗患者起搏器管理知识及心力衰竭疾病综合管理的健康教育和指导,提高患者自我管理信心和自我管理能力。

以心室收缩不同步作为心脏再同步化治疗筛选标准的疗效评价

目的:以心室收缩不同步作为心脏再同步化治疗的筛选标准,观察心脏再同步化(cardiac resynchronization therapy,CRT)治疗慢性心力衰竭(CHF)的临床疗效。方法:26例CHF患者经过严格的超声筛选后行CRT,全部患者均经冠状静脉窦植入左心室电极,电极位置尽量与超声提示的左心室收缩最延迟部位一致,术后随访(13.8±10.4)个月。结果:2例患者随访中死亡,其余24例患者治疗后心功能、患者活动度、心率变异性均明显改善(P<0.05),左心室舒张末内径从(77.0±9.4)mm缩小至(68.7±10.2)mm(P<0.05),左心室内各室壁收缩期达峰时间标准差从(48.4±17.9)ms减少至(30.2±18.6)ms(P<0.05)。术后1个月左心室16,12及6节段达最小容积点时间的标准差和最大时间差均有明显减低(P<0.05)。结论:CRT是CHF治疗的有效方法,术前应用常规超声心动图及组织多普勒成像技术(TDI)等多项技术来评价患者心室运动的失同步是CRT的有效筛选手段。

血清N-末端脑钠肽与心脏再同步化治疗慢性心衰患者预后的相关研究

目的 :探讨术前血清N-末端脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度与心脏再同步化治疗(cardiac resynchronization therapy,CRT)术后慢性心衰(chronic heart failure,CHF)患者心功能以及预后的关系。方法 :选择2012年3月—2014年10月在本院植入CRT或CRT-D的CHF患者60例,术前测定血浆NT-proBNP水平;术前以及术后6个月测定超声心动图测定左心室射血分数(left ventricular ejection fraction,LVEF)。依据CRT植入后6个月随访时LVEF绝对值较基线增加≥5%为标准,分为有反应组和无反应组。随访期间观察CHF患者主要不良心血管事件(major adverse cardiovascular events,MACE)。结果 :CRT术后有反应组术前NT-pro BNP、随访MACE发生率明显小于CRT无反应组(P<0.01)。以NT-proBNP2 354.5 pg/m L为最佳分界点,预测CRT术后无反应的敏感度为95.0%,特异度为92.5%。以NT-proBNP 2 254.5 pg/m L为最佳分界点,预测发生心血管事件的敏感度95.2%,特异度92.3%。Kaplan-Meier生存曲线显示NT-pro BNP≤2 254.5 pg/m L患者生存时间高于NT-proBNP≥2 254.5 pg/m L者(P<0.01)。结论:术前血清NT-proBNP水平与CHF患者CRT术后反应程度以及心血管不良事件相关。