肺动脉压力与心脏再同步化治疗疗效的相关性研究  

Associations between pulmonary artery systolic pressure and clinical outcome of cardiac resynchronization therapy

作　　者：汪菁峰[1] 秦胜梅[1] 宿燕岗[1] 崔洁[1] 柏瑾[1] 王蔚[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心脏内科,上海200032

出　　处：《中国心脏起搏与心电生理杂志》2013年第6期507-510,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的分析肺动脉收缩压(PASP)对心脏再同步化治疗(CRT)疗效的影响。方法 107例接受CRT手术的患者,根据其术前PASP测值分为三组:轻度组(PASP<50 mmHg),中度组(50 mmHg≤PASP<70 mmHg),重度组(PASP≥70 mmHg)。记录并比较三组患者CRT术后6个月心功能分级、QRS波时限、左室射血分数、左室舒张末内径和左室收缩末内径等超声心动图指标;比较三组CRT有效性,并通过受试者操作特性(ROC)曲线评估术前PASP对CRT有效性的预测价值。结果 CRT术后6月,轻度组心功能改善显著优于重度组(P<0.05);轻度组左室射血分数的提高、左室舒张末内径及左室收缩末内径的缩小亦显著优于另2组(P<0.05)。轻、中、重度组患者CRT有效率有显著差异(64.3%vs 50%vs 26.7%,P=0.028)。ROC曲线及曲线下面积0.653±0.053(P<0.01)。以PASP<55 mmHg预测CRT有效的灵敏度为75.9%,特异度为53.1%。结论中-重度肺动脉高压患者CRT疗效显著低于轻度肺动脉高压者,术前PASP对CRT反应性具有一定预测价值。Objective To analyze the impact of pulmonary artery systolic pressure（ PASP） on the clinical outcome after cardiac resynchronization therapy（ CRT）. Methods One hundred and seven consecutive patients who underwent CRT were enrolled. Subjects were stratified into three groups based on preoperative PASP： mild（ PASP 50 mmHg）,moderate（ 50 mm-Hg≤PASP 70 mmHg）,and severe（ PASP≥70 mmHg）. The data of cardiac function,QRS duration,left ventricular ejection fraction（ LVEF）,left ventricular end-diastolic diameter（ LVEDD） and end-systolic diameter（ LVESD） were assessed and compared among the three groups 6 months after CRT. We have also made a comparison of their CRT response. Receiver operating characteristic（ ROC） curve was applied to evaluate the effectiveness of preoperative PASP in predicting CRT response. Results At 6-month follow-up,the mild group showed a significantly better cardiac function than the severe group（ P 0.05）; Compared with the other two groups,the mild group also demonstrated an overall advantage concerning the improvement of LVEF,reduction of LVEDD and LVESD with statistical significance（ P 0. 05）. Significant differences of CRT responses could be observed among the three groups（ 64. 3% vs 50% vs 26. 7%,P = 0. 028）,ROC curve and area under curve（ AUC） showed that preoperative PASP could be predictive of CRT response to a certain extent（ P 0. 01）. Conclusion Moderate-to-severe pulmonary hypertension is associated with an adverse outcome of CRT. Preoperative PASP might predict CRT response.

关 键 词：心血管病学 心力衰竭 心脏再同步化治疗 肺动脉收缩压 

分 类 号：R541.61[医药卫生—心血管疾病] R318.11[医药卫生—内科学]