右心室心尖起搏伴心力衰竭患者升级心脏再同步化治疗的临床观察

目的 观察分析升级心脏再同步化治疗(CRT)对右心室心尖起搏伴心力衰竭患者的临床疗效.方法 对10例右心室心尖起搏伴心力衰竭,左心室射血分数(EF)≤35%的患者更换三腔起搏器,观察术后12个月患者的临床症状,并于术后6、12个月行超声检查,对心功能相关指标进行统计学分析.结果 术后12个月死亡2例,临床症状改善7例,存活的8例患者平均心功能NYHA分级提高,B型利钠肽下降[(184±73)ng/L比(545±286)ng/L],左房直径缩小[(43±5)mm比(46±7)mm],肺动脉压力下降[(42±6)mm Hg比(54±13)mm Hg],平均左心室EF提高[(32±4)%比(35±5)%],组织多普勒显示12节段达峰时间最大差[(136±28)比(97±18)ms]和室间收缩时间差[(52±5)ms比(31±6)ms)]均有改善(均P＜0.05).结论 CRT能改善右心室心尖起搏合并心力衰竭患者的症状和NYHA心功能分级,对于右心室心尖起搏发生心力衰竭的患者,CRT是可靠的治疗手段.

Abstract：

Objective To investigate the clinical efficacy of cardiac resynchronization therapy (CRT) through biventricular pacing in chronically right ventricular apical paced patients with heart failure. Methods Ten chronically right ventricular apical paced patients with left ventricular ejection fraction (EF)≤35% underwent CRT upgrading. And the follow-up period was over 12 months. Seven of them reported a significant improvement in their symptoms. Two patients died and one patient had no response. As compared with pre-CRT, CRT significantly improved NYHA classification, decreased left atrium diameter [(43 ±5) mm vs (46 ±7) mm], pulmonary arterial pressure [(42 ±6) mm Hg vs (54 ±13 ) nnn Hg] and BNP [( 184 ± 73 ) ng/L vs ( 545 ± 286 ) ng/L] ( P ＜ 0. 05 ), improved left ventricular EF [(35 ± 5 ) % vs ( 32 ± 4 ) %]. Tissue Doppler imaging revealed the maximal difference of time to peak myocardial systolic contraction of 12 left ventricular segment shortened [(136 ± 28) ms vs (97 ± 18 )ms],interventricular mechanical delay shortened [(52 ± 5 ) ms vs (31 ± 6 ) ms)] after upgrading. Conclusion CRT upgrading from right ventricular apical pacing may improve left ventricular function in patients with heart failure.

Upgrading to resynchronization therapy in patients with heart failure after chronic right ventricular apical pacing

Objective To investigate the clinical efficacy of cardiac resynchronization therapy (CRT) through biventricular pacing in chronically right ventricular apical paced patients with heart failure. Methods Ten chronically right ventricular apical paced patients with left ventricular ejection fraction (EF)≤35% underwent CRT upgrading. And the follow-up period was over 12 months. Seven of them reported a significant improvement in their symptoms. Two patients died and one patient had no response. As compared with pre-CRT, CRT significantly improved NYHA classification, decreased left atrium diameter [(43 ±5) mm vs (46 ±7) mm], pulmonary arterial pressure [(42 ±6) mm Hg vs (54 ±13 ) nnn Hg] and BNP [( 184 ± 73 ) ng/L vs ( 545 ± 286 ) ng/L] ( P ＜ 0. 05 ), improved left ventricular EF [(35 ± 5 ) % vs ( 32 ± 4 ) %]. Tissue Doppler imaging revealed the maximal difference of time to peak myocardial systolic contraction of 12 left ventricular segment shortened [(136 ± 28) ms vs (97 ± 18 )ms],interventricular mechanical delay shortened [(52 ± 5 ) ms vs (31 ± 6 ) ms)] after upgrading. Conclusion CRT upgrading from right ventricular apical pacing may improve left ventricular function in patients with heart failure.