心脏再同步治疗对慢性心力衰竭的临床疗效观察

目的观察心脏再同步治疗（CRT）对慢性心力衰竭的长期临床疗效。方法24例接受CRT的慢性心力衰竭患者，心功能Ⅲ～Ⅳ级（NYHA分级），左心室射血分数（LVEF）≤0．35，左心室舒张末内径（LVEDD）／〉55mm，QRS时限≥120／TIS。植入前超声心动图及组织多普勒检查以评价心功能及心脏收缩不同步指标，并指导左心室电极导线的植入。植入后3、6个月及随后的每6个月进行随访，随访内容包括临床症状、心电图、LVEDD、LVEF及多普勒超声评价心脏收缩同步性指标。结果随访时间（12．0±4．6）个月，结果显示患者临床症状明显改善，QRS时限植入后较植入前缩短[（137．50±38．96）ms对（144．60±45．78）ms，P=0．67]，但差异无统计学意义。植人后LVEDD较植入前明显缩小[（6．24±0．89）cm对（6．78±0．42）cm，P=0．03]；LVEF则明显提高（0．36±0．09对0．31±0．03，P〈0．01），左心房内径（LAD）也较术前明显缩小[（4．22±8．43）cm对（5．32±7．63）cm，P=0．01]。心脏收缩不同步指标与植入前相比也明显改善。结论对慢性心力衰竭的患者，CRT治疗可改善左心室功能，逆转左心室重构。

Long-term effects of cardiac resynchronization therapy in patients with congestive heart failure

Objective To observe the long-term effects of cardiac resynchronization therapy(CRT)in patients with congestive heart failure(CHF).Methods Twenty-four patients fulfilled the CRT indication with New York Heart Association(NYHA)Ⅲ～Ⅳ,QRS duration≥120 ms,LVEF≤0.35,LVEDD≥55 mm were studied by echocardiography before and after resynchronization.Intra-ventricular and inter-ventricular asynchrony were assessed by tissue Doppler imaging(TDI).Patients were followed up 3,6 monthes and every 6 monthes after operation.Results Patients were followed up for(12.0 ±4.6)months,with significant reduction of left ventricular end-diastolic(LVEDD)[(6.24±0.89)cm vs(6.78 ±0.42)cm,P=0.03]and left atrail dimension(LAD)[(4.22±8.43)cm vs(5.32±7.63)cm,P=0.01].The left vertricular ejection fraction (LVEF)Was increased(0.36±0.09 vs 0.31±0.03,P<0.01).The intra-ventricular and inter-ventricular asynchrony indexes were significantly improved.Conclusion CRT improves the LV systolic function associated with the LV reverse remodeling.