扩张型心肌病心肌病变对心脏再同步化治疗的影响

目的采用前瞻性自身对照研究的方法，应用双核素同时采集法单光子发射计算机断层（SPECT）显像评价扩张型心肌病（DCM）心肌病变的程度与心脏再同步化治疗（CRT）效果之间的关系。方法13例DCM心力衰竭患者成功植入CRT,并于术前及术后半年行SPECT检查，半定量分析方法评价手术前、后左室心肌灌注、代谢变化情况。结果术后左室缺血区、坏死区质量百分比均较术前明显降低（18．2±12．7）％vs（31．8±15．4）％，P〈0．05；（22．3±14．9）％VS（36．4±14．3）％，P〈0．051。术前坏死区质量百分比、总心肌灌注评分之和（F值）与CRT超声应答呈负相关（r=-0．578，P〈O．05；r=-0．619，P〈0．05）。心肌灌注0分的节段数（N。）与CRT临床症状好转呈正相关（r=0．81，P〈0．05）。术前Nn与术后左室收缩功能改善、左室逆转重塑呈正相关（r=-0．655，P〈0．05；r=0．719，P〈0．05）。结论术前心肌细胞坏死程度越大，CRT疗效越差；CRT治疗可使心肌局部血流灌注改善，部分心肌细胞代谢增强，心肌坏死程度较术前减轻。

Effect of myocardial pathological lesion on outcome of cardiac resynchronization therapy in patients with dilated cardiomyopathy

Objective To evaluate the relation between the myocardial pathological lesion and the outcome of cardiac resynchronization therapy （ CRT ） in patients with dilated cardiomyopathy （ DCM ） using 99mTc-methoxy-isobutylisonitrile （99mTc- MIBI） myocardial perfusion single photon emission tomography （SPECT） and JSF-fluoro-2-deoxy-D-glucose （18F-FDG） imaging. Methods Totally 13 cases of DCM patients with heart failure were successfully implanted with CRT device. SPECT imaging was performed 6-month before and after CRT. Left ventricular myocardial perfusion and metabolic changes were evaluated by semi- quantitative analysis method in all patients. Results Compared with preoperative left ventricular ischemia necrosis areas and mass percentage, significant decrease was observed postoperatively （18.2% ＋ 12.7%） vs （31.8% ＋ 15.4%）, P 〈 0.05; （22.3% ~ 14.9%） vs （36.4% ＋ 14.3%）, P 〈 0.05]. There was negative correlation between necrotic area mass percentage or total myocardial perfusion score before operation （ F value） and CRT response （r = -0.578, P 〈 0.05; r = -0.619, P 〈 0.05）, and significant positive correlation of preoperative myocardial perfusion zero score （ No ） with improved postoperative left ventricular systolic function （r = -0.655, P 〈 0.05） or left ventricular reverse remodeling （r = 0.719, P 〈 0.05）. Conclusion The greater the myocardial cell necrosis before CRT, the worse effects of CRT. CRT can improve the regional myocardial blood perfusion, increase myocardial cell metabolism and reduce the extent of myocardial necrosis.