心力衰竭患者心脏再同步化疗效的多因素分析

目的：探讨影响心力衰竭患者心脏再同步化治疗（CRT）效果的因素. 方法：入选因慢性心功能不全接受CRT的患者25例.CRT应答定义为术后6个月左室收缩末期容积（LVESV）减少＞15％以及纽约心功能改善1级以上（包括1级）,不达上述标准以及因心力衰竭死亡者定义为CRT无应答.对所有患者随访（26.0±15.9）个月,17例表现为CRT应答,8例表现为CRT无应答,分析两组患者的临床基线特征及治疗前后心功能分级、基线QRS波时限（QRSd）等指标,并作logistic回归分析. 结果：慢性心力衰竭患者对CRT的反应与QRSd（r=1.19,P=0.01）、术后QRSd缩短时间（ΔQRSd,r=1.28,P=0.01）相关.ROC曲线分析显示,基线QRSd＞135 ms预测CRT应答的敏感性为70.6％0、特异性为62.5％,ΔQRSd缩短25 ms预测CRT应答的敏感性为64.7％、特异性为90.9％. 结论：QRS波基线值和ΔQRSd是CRT应答的预测因子.

Multivariate analyse of effects on cardiac resynchronization therapy in patients with heart failure

Objective：To investigate the factors affecting the response to cardiac resynchronization therapy （CRT） in patients with heart failure （HF）.Methods：A cohort of 25 consecutive HF patients with standard CRT indications were enrolled in this study.Patients were classified as responders if they experienced≥15 ％ decrease in left ventricular end-systolic volume and the cardiac function （NYHA） was improved by one or more degree.After （26.0 ± 15.9） months＇ follow-up,17patients responded to CRT,and the others were nonresponders.The clinical baseline characteristics,cardiac function classification （NYHA）,and baseline QRS duration （QRSd） were analyzed between the two groups,and the meaningful parameters were subjected to logistic regression analysis.Results：By multivariable logistic regression,baseline QRSd （r =1.19,P =0.01） and difference of QRS duration after treatment （ΔQRSd） （r =1.28,P =0.01） were independent predictors of CRT response in patients with consecutive HF.The ROC curve analysis established that the optimal cut-off value of baseline QRSd was identified at 135 ms with a sensitivity of 70.6％ and a specificity of 62.5％.The optimal cut-off value,25 ms reduction in ΔQRSd exhibited a 64.7％ sensitivity and a 90.9％ specificity to predict responders.Conclusion：Baseline QRSd and ΔQRSd predict the clinical outcomes of CRT in patients with HF.