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目的探讨心力衰竭(简称心衰)患者心脏再同步化治疗(CRT)后6个月左房参数的变化及与CRT疗效的关系。方法入选因慢性心衰行CRT植入、随访6个月资料完整的患者30例,术前及术后6个月以超声心动图测量左房结构及功能参数,包括:左房前后径(LA-D1)、左房长径即上下径(LA-D2),左房横径(LA-D3)、左房最小容积(LAVmin)、左房最大容积(LAVmax)、左房射血分数(LAEF),同时测定左室射血分数(LVEF),并评价NY HA分级和6 min步行试验。按照术后6个月LAEF变化分为应答组(LAEF增加10%及以上)及无应答组(LAEF增加不足10%或反而下降),观察分析两组CRT疗效的变化特点。结果①CRT植入后6个月,左房各参数均较植入前明显好转(P<0.001),表现为LA-D1、LA-D2、LA-D3、LAVmin、LAVmax明显缩小,LAEF明显提高;同时心功能参数明显提高(P<0.001),表现为LVEF明显提高,6 min步行距离明显增加,心功能分级明显提高。②CRT治疗6个月后,应答组较无应答组的LVEF明显增加(P<0.05),LA-D1、LA-D2、LAVmax、LAVmin明显缩小(P<0.05~0.01),而LA-D3、6 min步行距离及心功能分级无变化(P>0.05)。结论 CRT治疗可有效逆转左房重构;CRT植入术后6个月左房参数的变化有助于评估CRT的疗效。
Objective To investigate the changes of left atrial parameters at 6 months after cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and its relationship with CRT. Methods Thirty patients with intact CRT at 6 months follow-up were enrolled in this study. Left atrial structure and functional parameters were measured by echocardiography before and 6 months after surgery, including left anterior and posterior dimensions (LA -D1), LA-D2, LA-D3, LAVmin, LAVmax, LAEF ), Left ventricular ejection fraction (LVEF) was measured at the same time, and NY HA classification and 6-min walking test were evaluated. According to the change of LAEF at 6 months after operation, the patients were divided into response group (LAEF increased by 10% or more) and no response group (LAEF increased less than 10% or decreased). The changes of CRT efficacy were observed and analyzed. Results ① The parameters of left atrium were significantly improved (P <0.001) at 6 months after CRT implantation. The LA-D1, LA-D2, LA-D3, LAVmin and LAVmax were significantly reduced and LAEF was significantly increased. At the same time, the parameters of cardiac function increased significantly (P <0.001), showing a significant increase of LVEF, a significant increase of 6 min walking distance and a significant increase of cardiac function grade. ② After 6 months of CRT treatment, LVEF in response group was significantly higher than that in non-responder group (P <0.05), LA-D1, LA-D2, LAVmax and LAVmin were significantly reduced min walking distance and heart function classification no change (P> 0.05). Conclusions CRT can effectively reverse left atrial remodeling. The change of left atrium parameters at 6 months after CRT implantation is helpful to evaluate the curative effect of CRT.