心脏再同步治疗超反应的预测因子分析

目的 心脏再同步治疗（CRT）能明显改善患者临床症状,逆转心肌重构,称之为CRT超反应.本文主要分析CRT术后,患者超反应的预测因子.方法 采用回顾性研究,2005年1月至2010年6月共有124例随访资料完整的CRT或心脏再同步治疗除颤器（CRT-D）纳入分析,分为超反应组及其他反应组.并在CRT术后第6个月随访时,进行临床评估及超声心动图评价.心功能（NYHA分级）提高≥1级,左心室射血分数（LVEF） ≥0.45或增加2倍以上称为超反应.结果 两组患者在基线状态除QRS时限（160.2±36.1）ms对（139.6±32.5）ms,P=0.01],完全左束支阻滞比例（95％对82％,P=0.02）、心力衰竭症状出现时间（21.0±14.6）个月对（36.0±25.3）个月,P=0.02]差异有统计学意义外,其余参数在基线状态差异无统计学意义；有17％的患者出现超反应.6个月随访时超反应组与其他反应组在心功能分级、脑钠肽（BNP）、QRS时限、LVEF及因心力衰竭住院率方面有明显改善.结论 完全左柬支阻滞及心力衰竭症状出现较短的患者CRT反应较好.

Predictors of super-response to cardiac resynchronization therapy

Objective The purpose of this study was to investigate the predictors of super-response to cardiac resynchronization therapy( CRT/CRT-D) in patients with heart failure.Methods A total of 124 patients who underwent CRT/CRT-D were studied from 2005 to 2010 and were divided into two groups:super-responders and non-superresponders.Before CRT and 6 months after,clinical and echocardiographic evaluation was performed.Patients with a improvement in NYHA function class≥ 1 grade,left ventricular ejection fraction(LVEF) ≥0.45 or two-fold or more increase were defined as super-responders.Results There were 17％ surper-responders.At baseline,there were no significant differerences between super-responders and non-superresponders,except for the QRS duration ( 160.2±36.1 ) ms vs.( 139.6±32.5 ) ms,P=0.01 ],shorter duration of heart failure symptoms (21.0± 14.6 ) months vs.( 36.0 ± 25.3 ) months,P =0.02 ],complete left bundle branch block ( CLBBB )(95％ vs.82％,P=0.02).After 6 months,there were significant differerences in NYHA class,BNP,QRS duration,LVEF and re-admissions for heart failure.Conclusion Heart failure patients with CLBBB and shorter duration are the predictors of super-response to CRT.