慢性心力衰竭患者心脏再同步化治疗无应答危险因素分析  

Risk factors of non-response to cardiac resynchronization therapy in patients with chronic heart failure

作　　者：高文霞[1] 纳丽莎[2] 叶晶晶[1] 刘丽文[3] 拓胜军[4] 左蕾[3] 张军[3] 朱文倩 

机构地区：[1]宁夏医科大学研究生院,2010级银川市750004 [2]宁夏医科大学总医院心脏中心心功能检查部,银川市750004 [3]解放军第四军医大学西京医院超声诊断科,西安市710032 [4]延安市人民医院超声诊断科,陕西省716000 [5]齐鲁医院沂南分院普外科,山东省临沂市276300

出　　处：《中华实用诊断与治疗杂志》2013年第2期115-117,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81170305);全军后勤科研计划面上项目(CWS11J056);陕西省科技计划项目(2012K15-02-03)

摘　　要：目的分析慢性心力衰竭患者心脏再同步化治疗(cardiac resynchronization therapy,CRT)无应答的危险因素。方法回顾性分析行CRT治疗的慢性心力衰竭患者109例,73例术后6个月左心室收缩末期容积增加≥10%为应答组,36例左心室收缩末期容积增加<10%为无应答组,收集患者术前一般临床资料、常规超声参数、同步化参数及左心室起搏电极位置等指标,采用Logistic回归分析影响CRT无应答的危险因素。结果 2组应答率为66.97%;Logistic回归分析结果显示,心功能差、缺血性心肌病、合并室性心动过速、左心室收缩末期容积增大为CRT无应答的危险因素(P<0.01);心室间延迟、合并左束支传导阻滞为CRT无应答的保护因素(P<0.01)。结论心室间延迟、合并左束支传导阻滞可提高CRT应答率,心功能差、缺血性心肌病、合并室性心动过速、较大的左心室收缩末期容积是无应答的危险因素。Objective To investigate the risk factors of non-response to cardiac resynchronization therapy （CRT） in patients with chronic heart failure （CHF）. Methods A total of 109 patients who underwent CRT were retrospectively analyzed. The patients with at least 10% increase in left ventricular end-systolic volume （LVESV） in 6 months after CRT were defined as responders （response group） and those with less than 10% increase in LVESV in 6 months after CRT were defined as non-responders （non-response group）. The clinical data, echocadiographic baseline characteristics, synchronization characteristics and left ventricular lead position were collected. Logistic regression analysis was used to investigate the risk factors of non-response to CRT. Results The response rate was 66. 97% in two groups. Logistic regression analysis showed that bad heartfunction, ischemic cardiomyopathy, ventricular tachycardia and the larger LVESV were the independent risk factors of non-response to CRT in patients with CHF （P（0.01）. Left bundle branch block and less interventricular delay were the protective factors of non-response to CRT in patients with CHF （P〈0.01）. Conclusion Left bundle branch block and less interventricular delay could improve response rate, but bad heartfunvtion, ventricular taehysardia, ischemic cardiomyopathy and larger LVESV are the independent risk factors of non-response to CRT in patients with CHF.

关 键 词：慢性心力衰竭 心脏再同步化治疗 无应答 危险因素 二分类Logistic回归 

分 类 号：R541.6[医药卫生—心血管疾病]