CRT 对扩张型和缺血性心肌病的左室机械重构疗效观察

目的 观察心脏再同步化起搏治疗（CRT）对扩张型和缺血性心肌病的左室机械重构疗效差别。 方法 入选21 例慢性充血性心力衰竭患者，分为扩张型心肌病组（13 例）和缺血型心肌病组（8 例）。所有 患者均符合CRT 指南的I 类适应证。分别观察CRT 术后6、12 个月左室射血分数、左房内径、左室收缩内 径、左室舒张内径、左室收缩末期容积、左室舒张末期容积及二尖瓣反流面积的变化。结果 ①扩张型心肌病 组CRT 术后6 个月，左室射血分数较术前增加，左室舒张和收缩末内径，左室舒张和收缩末容积，二尖瓣反流 面积较术前减少（P <0.05），术后12 个月，左室射血分数较术前增加，左室舒张和收缩末内径，左室舒张和收 缩末容积，左房内径较术前减小（P <0.05）；②缺血性心肌病组术后12 个月射血分数较术前增加（P <0.05）； ③扩张型心肌病组CRT 术后6 个月二尖瓣反流面积的变化量大于缺血性心肌病组（P <0.05），射血分数增加 量大于缺血性心肌病（P <0.05），术后12 个月扩张型心肌病组左室收缩末内径、左室舒张和收缩末容积的变化 量大于缺血性心肌病组（P <0.05）。结论 CRT 对扩张型心肌病患者的心室逆重构效果优于缺血性心肌病患者。

Effect of cardiac resynchronization therapy on left ventricular remodeling in ischemic and dilated cardiomyopathy

Objective To investigate the effect of cardiac resynchronization therapy (CRT) on left ventricular remodeling in patients with ischemic cardiomyopathy or dilated cardiomyopathy. Methods Twenty-one patients with congestive heart failure who were all in accordance with CRT guidelines for class I indication were enrolled. There were 13 patients with dilated cardiomyopathy and 8 patients with ischemic cardiomyopathy. The left ventricular ejection fraction (LVEF), left atrium diameter (LAD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and the area of mitral regurgitation (MRA) were observed 6 and 12 months after CRT. Results In the dilated cardiomyopathy patients, LVEF was increased, and LVESD, LVEDD, LVEDV, LVESV and MRA were reduced 6 months after CRT (P < 0.05); LVEF was increased while LVESD, LVEDD, LVEDV, LVESV and LAD were reduced 12 months after CRT (P < 0.05). In the ischemic cardiomyopathy group, LVEF was increased 12 months after CRT (P < 0.05). MRA and LVEF in the dilated cardiomyopathy group were changed more remarkably than those of the ischemic cardiomyopathy group 6 months after CRT (P < 0.05); LVESD, LVEDV and LVESV in the dilated cardiomyopathy group were changed more remarkably than those of the ischemic cardiomyopathy group 12 months after CRT (P < 0.05). Conclusions The effect of CRT on left ventricular remodeling in patients with dilated cardiomyopathy is much better than that in patients with ischemic cardiomyopathy.