心脏再同步化治疗与心力衰竭患者的心脏电学逆重构  

Relationship between reverse structural remodeling and electrical remodeling after cardiac resynchronization therapy

作　　者：吴冬燕[1] 骆永娟[1] 马薇[1] 李琼[1] 许静[1] 卢凤民[1] 

机构地区：[1]天津市胸科医院,天津300222

出　　处：《中国心脏起搏与心电生理杂志》2015年第1期14-17,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨心脏再同步化治疗(CRT)是否会纠正心力衰竭患者的电重构现象。方法回顾分析伴有完全性左束支传导阻滞的心力衰竭患者接受CRT后随访观察1年,分别在术中电极安置后和术后1年测试自身心律下右室-左室电极的激动时间差(△t),右室电极刺激到左室电极感知时间(RVp-LV)及左室电极刺激到右室电极感知时间(LVp-RV),比较CRT应答者与无应答者的自身QRS波时限、双室起搏下QRS波时限和△t、RVp-LV、LVp-RV。结果共入选51例,应答组(36例),无应答组(15例)。应答组术前和术后1年相比,△t和RVp-LV缩短(P<0.05)。无应答组术前与术后1年比较,△t、RVp-LV延长(P<0.05)。两组自身QRS波时限无差异,但术后1年无应答组起搏下QRS波时限延长。结论 CRT应答患者发生了电学逆重构。起搏QRS波时限改变与CRT疗效有关。Objective To explore the relationship between reverse electrical remodeling and reverse structural remodeling in cardiac resynchronization therapy（CRT）. Method The width of native QRS and biventricular paced QRS were measured in lead Ⅱ electrocardiogram before and 1 year after CRT implantation. The interval between the onset of right ventricle （RV） lead and LV lead electrograms （At） ,the interval between RV pacing to LV sensing （RVp-LV）, the interval LV pacing RV sensing（LYp-RV）were measure by QuickOpt program at baseline and 1year post-CRT implantation. A reduction of LV end-systolic volume ≥ 15% or improvement of LV ejection fraction≥ 5% was used to define CRT responders. Results Patients with （36） and without （15） significant structural reverse remodelling had similar baseline characteristics. At 1 year of follow-up, CRT responders exhibited a significant decrease in A t （P〈0.05） , RVp-LV and pacing QRS width（P〈0.001 ）. However, CRT non-responders exhibited a significant increase in At ,RVp-LV and pacing QRS width （P〈0.001）. Conclusion Reverse structural remodelling is associated with reversal of electrical remodeling. The change of paced QRS width is more sensitive to CRT response.

关 键 词：心血管病学 心力衰竭 心脏再同步化治疗 电重构 结构重构 

分 类 号：R541.62[医药卫生—心血管疾病] R541.61[医药卫生—内科学]