以心室收缩不同步作为心脏再同步化治疗筛选标准的疗效评价

目的:以心室收缩不同步作为心脏再同步化治疗的筛选标准,观察心脏再同步化(cardiac resynchronization therapy,CRT)治疗慢性心力衰竭(CHF)的临床疗效。方法:26例CHF患者经过严格的超声筛选后行CRT,全部患者均经冠状静脉窦植入左心室电极,电极位置尽量与超声提示的左心室收缩最延迟部位一致,术后随访(13.8±10.4)个月。结果:2例患者随访中死亡,其余24例患者治疗后心功能、患者活动度、心率变异性均明显改善(P0.05),左心室舒张末内径从(77.0±9.4)mm缩小至(68.7±10.2)mm(P0.05),左心室内各室壁收缩期达峰时间标准差从(48.4±17.9)ms减少至(30.2±18.6)ms(P0.05)。术后1个月左心室16,12及6节段达最小容积点时间的标准差和最大时间差均有明显减低(P0.05)。结论:CRT是CHF治疗的有效方法,术前应用常规超声心动图及组织多普勒成像技术(TDI)等多项技术来评价患者心室运动的失同步是CRT的有效筛选手段。

Clinical effect of cardiac resynchronization therapy for patients with chronic heart failure and biventricular asynchronization

Objective：This study was designed to evaluate the role of cardiac resynchronization therapy（CRT） in chronic heart failure（CHF） patients with echocardiographic evidence of mechanical asynchrony.Methods： Twenty-six CHF patients with echocardiographic evidence of mechanical asynchrony received CRT,and left ventricle leads were implanted into one of cardiac veins.The location of left ventricle lead was equal pace to the position that was the most delayed contraction symptom by echocardiography as far as possible.Results： Two patients died during follow up.Improvement of NYHA functional class,maximal exercise capacity and heart rate variability（both P0.05）was observed in the other 24 patients after CRT.There was a significant reduction of left ventricular end-diastolic dimension（LVEDD） from（77.0±9.4） mm to（68.7±10.2） mm,（P0.05）.Standard deviation of time to regional peak systolic velocity（Ts-Sd-12） was decreased from（48.4±17.9）ms to（30.2±18.6） ms（P0.05）.The dispersion of time to minimum regional volume for 16,12 and 6 left ventricular segment（Tmsv16-SD,Tmsv12-SD and Tmsv6-SD）,and the maximum difference of time to minimum regional volume for 16,12 and 6 left ventricular segment（Tmsv16-Dif,Tmsv12-Dif and Tmsv6-Dif） has significantly decreased at 1 month follow up（P0.05）.Conclusion： CRT is an effective treatment for CHF patients with echocardiographic evidence of mechanical asynchrony.Routine ultrasound,TDI and other techniques before procedure of CRT are helpful for selecting patients with mechanical asynchrony.