心脏再同步治疗慢性心力衰竭患者的临床分析

目的评价心脏再同步治疗(cardiac resynchronization therapy,CRT)慢性心力衰竭的临床疗效。方法选择接受CRT的慢性心力衰竭患者29例,术后定期随访,观察患者心功能、LVEF、左心室舒张末内径(LVEDD),评价CRT的临床疗效,临床有效定义为心功能NYHA分级改善1级以上;超声心动图有效定义为左心室舒张末容积缩小>15%或LVEF绝对值增加>0.05%;否则定义为对CRT无反应。结果随访6～24(8.7±8.3)个月。与CRT前比较,术后21例LVEDD明显缩小,心功能分级明显减轻,LVEF明显增加,差异有统计学意义[(73.9±8.0)mm vs(68.7±10.2)mm,(3.1±0.1)级vs(2.0±0.1)级,(34±7)vs(42±6)%,P<0.05];临床对CRT的反应:有效21例,发生率为72.4%;对CRT无反应8例,发生率为27.6%,其中包括死亡2例。结论 CRT能改善慢性心力衰竭患者的左心室收缩功能,改善症状;对CRT的反应与入选患者是否真正存在心脏机械收缩不同步有关。

Cardiac resynchronization therapy for chronic heart failure

Objective To assess the clinical outcomes in chronic heart failure(CHF) patients after cardiac resynchronization therapy(CRT).Methods Twenty-nine CHF patients who underwent CRT were included in this study.The patients were regularly followed up,during which their heart function,left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter (LVEDD) were observed and their clinical outcomes after CRT were assessed.The clinical outcome was defined as effective when the heart function was>grade 1 according to the NYHA classification or when the left ventricular end systolic volume was>15%or the absolute LVEF value was>0.05%according to the echocardiographic findings.Otherwise,it was defined as non-response to CRT.Results The patients were followed up for 6-24 months(8.7±8.3 months). The LVEDD was significantly shorter,the heart function grade was significantly lower,and the LVEF value was significantly higher in 21 patients after CRT than before CRT(73.9±8.0 mm vs 68.7±10.2 mm,3.1±0.1 vs 2.0±0.1,34±7%vs 42 + 6%,P<0.05).Of the 29 patients,21 (72.4%) had response to CRT and 8(27.6%) had no response to CRT including 2 who died.Conclusion CRT can improve the systolic function of left ventricule and response to CRT is related with the non-synchronic heart mechanical contraction in CHF patients.