心脏再同步化治疗起搏参数优化对心脏同步性及心功能的影响  

Effect of cardiac resynchronization therapy on cardiac function post A-V and V-V optimization

作　　者：林纯莹[1] 陈泗林[1] 何亚乐[1] 费洪文[1] 薛玉梅[1] 刘烈[1] 梁远红[1] 吴书林[1] 

机构地区：[1]广东省人民医院心内科,广州510100

出　　处：《中华心血管病杂志》2007年第12期1105-1107,共3页Chinese Journal of Cardiology

基　　金：广东省重点攻关项目(2006B36007014)

摘　　要：目的应用组织多普勒研究心脏再同步化治疗(CRT)术后 A-V、V-V 间期优化对心脏同步性能及心功能的影响,探索 A-V、V-V 间期优化在增强 CRT 临床疗效中的作用。方法 32例慢性心力衰竭患者接受 CRT 治疗,手术后7天、3个月、6个月进行 A-V、V-V 间期优化,观察心脏同步性和心功能变化。采用彩色超声诊断仪进行图像采集及下线分析。结果经观察,术后7天、3个月、6个月的 A-V 间期需行优化的例数分别为28例、10例、6例,V-V 间期需行优化的例数分别为29例、6例、5例。与 CRT 术前相比:CRT 治疗术后未优化时的左室12节段组织速度达峰时间标准差明显改善[(68.8±26.4)ms 与(41.6±23.1)ms,P<0.01],左室射血分数增加[(28±4)%与(31±3)%,P<0.05],主动脉瓣前向血流速度时间积分增加[(13.6±3.1)cm 与(15.5±4.3)cm,P<0.05],舒张早期跨二尖瓣血流峰速和舒张早期心肌组织运动峰速的比值下降(13.1±5.3与9.3±4.3,P<0.05),左室舒张充盈时间延长[(313.2±93.6)ms 与(368.6±97.1)ms,P<0.05]。与术后未优化时相比:术后7天优化心脏同步性指标进一步改善(P<0.05),心功能指标无明显改变;术后3个月、6个月优化与术后7天优化相比,心脏同步性指标无明显改变,P>0.05;术后6个月优化的左室射血分数增加,左室舒张充盈时间延长,P<0.01。结论 CRT 术后7天,A-V、V-V 间期优化治疗改善心脏同步指标;术后6个月优化进一步改善心功能。Objective To assess the effect of A-V,V-V delay optimization on cardiac function and clinical improvement in patients with refractory heart failure underwent cardiac resynchronization therapy （CRT）. Method Thirty-two patients with chronic heart failure received CRT and cardiac function was measured at 7 days, 3 months and 6 months pest CRT before and after A-V and V-V delay optimizations. Results A-V delay optimization was initiated in 28, 10 and 6 cases at 7th day, 3rd month and 6th month after CRT. V-V delay optimization was performed in 29, 6 and 5 cases at 7th day, 3rd month and 6th month after CRT. Ts-SD, LVEF, VTI and E/Era were significantly improved after CRT compared to pre-CRT （P 〈0.01, P〈0.05, P〈0.05, P 〈0.05; respectively）. Compared to pre-optimization, the indexes of ventricular synchronization were significantly improved （ P 〈 0. 05 ） while indexes of cardiac function remained unchanged pest optimization at 7th day after CRT. The indexes of ventricular synchronization pest optimization were similar at 7th, 3rd and 6th months after CRT （P 〉0. 05）. LVEF and diastolic filling time were significantly increased after 6 months CRT pest A-V,V-V delay optimization （ P 〈 0. 01 ）. Conclusion A-V,V-V delay optimization at 7th day after CRT can significantly improve ventricular synchronization and is associated with further improved cardiac function 6 months after CRT.

关 键 词：心力衰竭 充血性 心脏起搏 人工 超声心动描记术 多普勒 

分 类 号：R541.6[医药卫生—心血管疾病]