心脏再同步治疗对不同病因心力衰竭的短期疗效

目的：探讨心脏再同步治疗（ cardiac resynchronization therapy，CRT）对不同病因心力衰竭患者的短期疗效。方法选择2011年3月-2013年9月收治的慢性充血性心力衰竭32例，按心力衰竭病因分为缺血性心肌病（ is-chemic cardiomyopathy，ICM）组11例和非缺血性心肌病（ non-ischemic cardiomyopathy，NICM）组21例。两组均给予CRT，观察术前及术后6个月临床、超声心动图指标及超声应答率。结果两组 CRT 术后6个月 NYHA 心功能分级及6 min步行距离均较术前改善（P 〈0.05）。NICM 组术后6个月左心室舒张末内径（LVEDD）、左心室收缩末内径（LVESD）、左心室舒张末容积（LVEDV）、左心室收缩末容积（LVESV）、左心房容积（LAV）及左心室射血分数（LVEF）较术前均明显改善，ICM 组 LVESD、LVESV、LAV及 LVEF较术前也明显改善（ P 〈0.05），NICM 组术后6个月 LVEF、LVESV改善情况优于 ICM 组（P〈0.05）。两组 CRT术后6个月超声应答率比较差异无统计学意义（P〉0.05）。CRT术后6个月 NICM 组ΔLVEF高于 ICM 组，ΔLVESV低于 ICM 组（P〈0.05）。结论不同病因心力衰竭患者对 CRT临床获益相似。CRT术后6个月 NICM 患者获益更佳，表现为更加显著的左心室逆重构以及心功能改善。

Short-term Effect of Cardiac Resynchronization Therapy on Patients with Different Etiologies of Congestive Heart Failure

Objective To explore the short-term effects of cardiac resynchronization therapy（ CRT）on patients with different etiologies of congestive heart failure. Methods A total of 32 patients with congestive heart failure during March 2011 and September 2013 were divided into ischemic cardiomyopathy group（ICM group,n=11）and non-ische-mic cardiomyopathy group（NICM,n =21）according to heart failure etiology. The CRT was performed in the two groups,and clinic and echocardiographic indexes,and echocardiographic response rate were observed before and six months after CRT. Results Compared with those before CRT,NYHA（ New York Heart Association）cardiac functional grading and 6-minute walking distance（6MWD）of patients in two groups were significantly improved six months after CRT（P〈0. 05）. The levels of left ventricular end-diastolic dimension（LVEDD）,left ventricular end-systolic dimen-sion（ LVESD）,left ventricular end-diastolic volume（ LVEDV）,left ventricular end-systolic volume（ LVESV）,left a-trium volume（ LAV）and left ventricular ejection fraction（ LVEF）in NICM group were significantly improved six months after CRT compared with those before CRT,while the levels of LVESD,LVESV,LAV and LVEF in ICM group were sig-nificantly improved after CRT compared with those before CRT（P〈0. 05）. Six months after CRT,there were significant improvements in LVEF and LVESV in NICM group than those in ICM group（P〈0. 05）. The difference in echocardio-graphic response rate was not statistically significant six months after CRT between the two groups（ P 〉0. 05 ）. Six months after CRT,the ΔLVEF level was higher,and the ΔLVESV level was lower in NICM group than those in ICM group（P〈0. 05）. Conclusion There is no obvious difference in the clinical benefits of CRT between two groups in spite of different etiologies. It seems that there are more echocardiographic benefits six months after CRT in NICM group and there are significantly greater left ventricular reverse remodeling an