单中心心脏再同步治疗的长期病死率及原因分析  

Mortality and cause in congestive heart failure patients with cardiac resynchronization therapy

作　　者：王冬梅[1] 韩雅玲[1] 臧红云[1] 于海波[1] 周薇薇[2] 张东红[1] 田芸[1] 

机构地区：[1]沈阳军区总医院心内科, 110016 [2]沈阳军区总医院超声科, 110016

出　　处：《中华心律失常学杂志》2011年第2期107-111,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的观察本中心心脏再同步治疗（CRT）的长期病死率，分析可能的相关因素。方法2001年3月至2010年4月135例患者行CRT治疗，男106例，平均年龄（59．95±11．14）岁。缺血性心肌病（ICM）44例，心功能Ⅲ～Ⅳ级（NYHA分级），LVEF≤0．35。随访最长9年。结果全因死亡率为31．11％，其中心力衰竭占26．19％，猝死占38．1％。与存活患者比较，心力衰竭恶化死亡患者更年轻、CRT治疗前的临床指标差、肺动脉压高、左心室舒张末内径增大明显（P〈0．05），而且PR间期明显延长（P〈0．05），不理想的左心室电极导线位置（心中静脉和心大静脉）的比例增加（P〈0．01）。非心力衰竭死亡组CRT治疗后心功能的各项指标及活动耐量均改善，且随着时间延长改善更明显，而心力衰竭死亡组随着时间延长病情反复且加重。结论本中心CRT长期治疗的全因死亡率为31％，死亡原因中心脏性猝死发生率最高，心力衰竭恶化排第2位，经CRT后因心力衰竭和猝死导致的死亡率低于以前药物治疗（20％／4年和〉50％／5年）。对于心功能好转的患者预防猝死是重要的，心脏再同步治疗除颤器（CRT－D）应是首选治疗。Objective To evaluate the mortality and analyze the relevant factors lead to died after cardiac resynchronization therapy（CRT） in patients with chronic congestive heart failure （CHF）. Methods One hundred thirty five patients with NYHA function class Ⅲ - IV and left ventricular ejection fraction（LVEF） 0. 35 [ 106 men,age（59.95 ± 11.14）years] underwent CRT were enrolled in this study. They were followed up for 9 years. Results Forty two patients （31.11% ）were died for different reasons from March 2001 to September 2010. The main cause of death was attributed to getting worse heart failure in 11 patients （ 11/42, 26. 19% ）. The sudden cardiac death was in 16 patients（ 16/42,38.1% ）. Heart function was improved significantly before the patients died except the cause of death was due to refractory heart failure. Comparing with the survival, the deaths were younger and poor heart function （ P 〈 O. 05 ）, large LVEDD （ P 〈 0. 05 ）, higher PASP （ P 〈 0. 05 ） and prolonging PR interval （ P 〈 0. 05 ） before CRT implantation. The heart function parameters of the deaths after CRT implantation were improved significantly, and the longer time was, the better heart function was except the deaths from refractory heart failure. Conclusion All-cause Mortality after CRT was 31% in our center during 9 years followed up, and sudden death was highest. The death from worsening heart failure was secondly. But the death from worsening heart failure and sudden cardiac death after CRT was lower compared with only reviewing the medical（ 20%/4 year vs 〉 50%/5 year）. Preventing sudden cardiac death was very important in the patients after heart function improved.

关 键 词：心脏再同步治疗 死亡率 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]