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目的评价心脏再同步化治疗(CRT)对慢性心力衰竭患者的临床和超声心动图疗效,总结 CRT 无效的原因。方法研究施行 CRT 的患者53例,男37例,女16例,年龄41～82岁。患者术前均采用血流多普勒和组织多普勒的方法进行收缩不同步的评价,术前和术后6个月进行美国纽约心脏病学会(NYHA)心功能分级评价、心电图和超声心动图检查。临床有效者定义为术后6个月NYHA 心功能分级改善1级以上的患者。超声心动图有效者定义为术后6个月左室收缩末容积缩小>15%或左室射血分数绝对值增加>5%的患者。结果 CRT 术后6个月时,7例患者死亡,46例患者存活。其中 NYHA 心功能分级至少改善1级者40例,临床有效率为75.5%;超声心动图有效者37例(69.8%)。术后6个月:左心室缩小;左室射血分数由(27.4±6.7)%增加到(40.4±10.0)%,P<0.01;左心房内径缩小;二尖瓣反流减少;肺动脉收缩压由(49.6±13.6)mm Hg(1 mm Hg=0.133 kPa)降低为(38.7±14.5)mm Hg。窦性心律组(42例)的超声有效率显著高于心房颤动组(11例)。在窦性心律患者中,与 CRT 无效组(10例)相比,有效组(32例)起搏前的 QRS 较宽(P<0.05),肺动脉收缩压较低(P<0.05),左室射血前时间较长(P<0.05);起搏前两组间腔室大小、LVEF、二尖瓣反流面积和组织多普勒的各个收缩不同步参数的差异无统计学意义。结论 CRT 能改善心力衰竭患者的左室收缩功能和左室重构,减少二尖瓣反流,降低肺动脉收缩压。窦性心律组的CRT 疗效优于心房颤动组。在非缺血性心肌病和左束支传导阻滞患者占多数的研究中,QRS 宽度、左室射血前时间和肺动脉收缩压可能预测 CRT 的疗效。
Objective To evaluate the clinical and echocardiographic effects of cardiac resynchronization therapy (CRT) on patients with chronic heart failure and to summarize the causes of the failure of CRT. Methods 53 patients with CRT were studied, including 37 males and 16 females, aged 41-82 years. The patients were preoperatively assessed by the method of flow Doppler and Tissue Doppler. The preoperative and postoperative 6 months were evaluated by New York Heart Association (NYHA) cardiac function classification, electrocardiogram and echocardiography Figure check. The clinically effective was defined as NYHA cardiac function improvement of grade 1 or higher 6 months after surgery. Echocardiogram-effective was defined as a decrease in left ventricular end-systolic volume of> 15% at 6 months or a> 5% absolute increase in left ventricular ejection fraction. Results At 6 months after CRT, 7 patients died and 46 patients survived. Among them, NYHA improved the cardiac function grade by at least 40%, the clinical effective rate was 75.5%, and echocardiography was effective in 37 cases (69.8%). After 6 months, the left ventricle was reduced; the left ventricular ejection fraction increased from (27.4 ± 6.7)% to (40.4 ± 10.0)%, P <0.01; the diameter of the left atrium was reduced; mitral regurgitation was reduced; pulmonary artery systolic pressure From (49.6 ± 13.6) mm Hg (1 mm Hg = 0.133 kPa) to (38.7 ± 14.5) mm Hg. Sinus rhythm group (42 cases) ultrasound efficiency was significantly higher than the atrial fibrillation group (11 cases). In sinus rhythm patients, compared with CRT ineffective group (n = 10), the effective group (n = 32) had a higher QRS before pacing (p <0.05), lower pulmonary systolic pressure (p < The time before ejection was longer (P <0.05). There was no significant difference in systolic and systolic parameters between the two groups before pacing in terms of chamber size, LVEF, mitral regurgitation area and tissue Doppler. Conclusion CRT can improve left ventricular systolic function and left ventricular remodeling in patients with heart failure, reduce mitral regurgitation and reduce pulmonary artery systolic pressure. CRT in sinus rhythm group is better than atrial fibrillation group. In patients with a majority of patients with nonischemic cardiomyopathy and left bundle branch block, QRS width, left ventricular ejection fraction, and pulmonary artery systolic pressure may predict the efficacy of CRT.