超声指导下心脏再同步治疗后参数优化的研究

目的探讨如何进行参数优化以提高心脏再同步化治疗(CRT)疗效。方法对8例慢性心力衰竭CRT患者,术后在超声心动图指导下优化AV间期,在组织多普勒显像下优化VV间期,达到CRT最佳治疗目的。结果8例CRT后心功能都得到改善,心功能NYHA分级,从Ⅲ～Ⅳ级改善为Ⅱ～Ⅲ级,起搏时的AV间期与窦性心律时的AV间期之比优化至130～180/100～150ms,使得左室充盈时间从354±147ms升至420±112ms,二尖瓣返流由8.41±4.55cm2减少至5.36±4.71cm2;VV间期优化至4～40ms,使得左室内各室壁收缩期达峰时间标准差从48.4±17.9ms减少至30.2±18.6ms,左室流出道速度时间积分由20.6±9.0cm/s上升至26.1±3.1cm/s。结论术后个体化的参数优化可以提高CRT疗效。

Study of the optimal pacemaker parameters in cardiac resynchronization therapy guided by ultrasound

Objective To approach how to optimize the pacemaker parameters in order to enhance the efficacy of cardiac resynchronization therapy(CRT).Methods Eight patients with chronic heart failure received cardiac resynchronous pacing.AV delay was optimized by ultrasound cardiography,and VV delay was optimized by tissue Doppler imaging.Results The heart function of 8 patients was significantly improved after the treatment.The NYHA class of the patients was improved from classⅢ～IV to class Ⅱ～Ⅲ.After PAV /SAV was optimized to 130～180 /100～150 ms,left ventricular filling time was increased from 354±147 ms to 420±112 ms,and mitral reflux was decreased from 8.41±4.55 cm2 to 5.36±4.71 cm2.After VV delay was optimized to 4～40 ms,standard deviation of time to regional peak systolic velocity was decreased from 48.4±17.9 ms to 30.2±18.6 ms,and left ventricular outflow tract velocity time integral was increased from 20.6±9.0 cm/s to 26.1±3.1 cm/s.Conclusions Optimization of the pacemaker parameters is needed in order to enhance the efficacy of CRT.