心脏再同步治疗的研究进展

充血性心力衰竭是具有较高住院率和死亡率的一种严重的心血管疾病。充血性心力衰竭的主要治疗模式是基于抗神经激素和肾素-血管紧张素轴途径,这些药物治疗可缓解症状,有时亦会改善心脏结构异常,是心力衰竭治疗的基石。近30%的晚期心力衰竭患者伴有心脏电传导异常,导致心室收缩不同步。这种非同步收缩会导致心脏病理生理学改变,加重心力衰竭。因此,心脏起搏技术可能被用于恢复心室同步收缩。近来,国际上进行了一系列多中心临床研究表明,心脏再同步治疗可以改善患者心功能,提高患者运动耐量及生活质量。心脏再同步治疗在改善患者心脏结构和功能的同时,也明显降低心力衰竭恶化的危险。

The Progress of Cardiac Resynchronization Therapy for Congestive Heart Failure

Patients with congestive heart failure have high rates of hospitalization and mortality.The primary mode of therapy for this syndrome is based on antagonism of neurohormonal pathways and the renin-angiotensinaldosterone axis activated in the failing cardiovascular system.These drugs can decrease morbidity and in some cases improve the underlying structural abnormalities of the heart and have become the cornerstone of therapy for heart failure. Approximately 30 percent of patients with heart failure have intraventricular conduction delay,such as left or right bundle-branch block,leading to loss of coordination of ventricular contraction.This dyssynchronous pattern of ventricular contraction is believed to contribute to the pathophysiology of heart failure.Accordingly,cardiac-pacing technology might be used to restore the synchrony of ventricular contraction.Results from several multicentre clinical trials have consistently demonstrated significant improvements in quality of life,functional status,and exercise capacity in NYHA class III and IV heart failure patients assigned to active resynchronization therapy.In these patients,cardiac resynchronization has also been shown to improve cardiac structure and function,while significantly reducing the risk of worsening heart failure.