左心室大小和术后收缩压变化与心脏再同步化治疗疗效的关系

目的:观察左心室（LV）大小和术后急性期收缩压（SBP） 变化对心脏再同步化治疗（CRT ）疗效的影响。方法: 分别于术前及术后 6 个月评估21例CRT患者的心功能及超声参数。至术后 6个月时，NYHA 至少下降1级，左室收缩末容积（LVESV）至少降低10%的为CRT反应较好组，余为反应较差组。结果: 术后6个月时，反应较好组和其基线期相比左室射血分数（LVEF）显著升高［（32±9）% vs. (45±10)%，P<0.05）］、左室舒张末容积（LVEDV）显著降低［（237±54）ml vs. (151±45) ml，P<0.05］、左室舒张末内径（LVEDD）显著降低［（68±8） mm vs. (55±6) mm，P<0.05］、左室收缩末容积（LVESV）显著降低［（165±46） ml vs. (84±31) ml，P=0.01］、NYHA 的分级由术前6/8（III/IV）降至术后11/3(II/III)；反应较差组和术前相比有所改善，未达到统计学意义。反应较好组术后7d SBP均显著升高（P<0.05）,反应较差组下降。结论: 心力衰竭患者CRT治疗反应较好与治疗前左心室较小和术后急性期SBP升高有关联性。

Effects of left ventricular geometry and postoperative blood pressure changes on efficacy of cardiac resynchronization therapy

AIM:To study the effects of left ventricular (LV) geometry and postoperative systolic blood pressure (SBP) changes on the efficacy of cardiac resynchronization therapy (CRT). METHODS: Twenty-one CRT recipients were included in the study. Before CRT and 6 months after, clinical and echocardigraphic evaluations were performed. At 6 months after CRT, the patients with a decrease of NYHA≥1 and a decrease of LVESV ≥10% were classified as CRT-responders and the others were classified as CRT-nonresponders. RESULTS: At baseline, no significant difference was observed in all patients except that CRT-responders had smaller LVEDD and better renal function. At 6 months after CRT, LVEF increased ［(32±9)% vs. (45±10)%, P<0.05］, whereas NYHA (6/8, III/IV vs. 11/3, II/III), LVEDD ［(68±8)mm vs.(55±6)mm, P<0.05］, LVEDV ［(237±54)ml vs.(151±45)ml, P<0.05］ and LVESV ［(165±46) ml vs. (84±31), P=0.01］ decreased in CRT-responders. No significant improvement was observed in CRT-nonresponders. A marked increase of SBP was found in CRT-responders. CONCLUSION: Less-altered ventricular geometry, smaller LVEDD and a prompt SBP rise just after CRT may predict a better response in CRT recipients.