左心室压力变化率评价心脏再同步化治疗术后短期疗效价值

目的 探讨左心室压力变化率评价心力衰竭患者心脏再同步化治疗术后短期疗效的价值。方法 有二尖瓣反流、接受心脏再同步化治疗的心力衰竭患者17例,测量术前、术后1个月左心室舒张末期内径和收缩末期内径、左心室舒张末期容积和收缩末期容积、二尖瓣反流面积,采用双平面Simpsons法测量左室射血分数,在连续多普勒频谱图上测量二尖瓣反流压差速率1~3m/s两点间时间,估测左心室压力变化率。结果 心脏再同步化治疗后1个月,左心室舒张末期内径、收缩期末期内径、左心室舒张末期容积、收缩末期容积（（76.3±8.7）mm、（64.7±9.3mm、（232±54）mL、（168±48）mL）较治疗前（（78.3±8.5）mm、（69.2±8.4）mm、（270±59）mL、（207±47）mL）明显降低（P〈0.01）;二尖瓣反流面积（6.5±3.9）mm2较治疗前（9.2±4.1）mm2明显缩小（P〈0.05）;左室射血分数、左心室压力变化率（（27.4±8.6）%、（598±141）mm Hg/s））较治疗前（（21.5±5.1）%、（473±132）mm Hg/s）明显升高（P〈0.01）。结论 左心室压力变化率是目前评价心肌再同步化治疗术后短期疗效的有效指标之一。

Value of left ventricular positive and negative dp/dt to evaluating the short-term effect of cardiac dsynchronization therapy

Objective To explore the value of left venticular positive and negative dp/dt to evaluating the short-term effect of cardiac resynchronization therapy （CRT） on heart failure. Methods Seventeen congestive heart failure patients with mitral regurgitation receiving CRT were measured the left ventricular end-diastolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD）, left ventricular end-systolic volume （LVESV）, left ventricular end-diastolic volume （LVEDV） and area of mitral regurgitation before and one month after CRT. Biplane Simpson＇s method was used to measure left ventricular ejection fraction （LVEF）, and dp/dt was estimated by measuring the time interval between 1 and 3 m/s on the mitral regurgitation continuous-wave Doppler spectrum. Results The LVEDD, LVESD, LVEDV and LVESV decreased significantly from （78.3±8.5） mm, （69.2±8.4） mm, （270±59） mL and （2074-47） mL before CRT to （76.3±8.7） mm, （64. 7±9.3） mm, （232±54） mL and （168±48） mL after CRT （P〈0.01）, the area of mitral regurgitation decreased from （9.2±4.1） mm2 to （6.5±3.9） mm2 （P〈0.05）, and LVEF and dp/dt increased markedly from （21.5±5.1）% and （473±132） mm Hg/s to （27.4±8.6）% and （598.±141） mm Hg/s） （P〈0.01）. Conclusion The detection of left ventricular positive and negative dp/dt is one of the effective techniques for assessing the short-term effect of CRT.