左心室电极位置对心脏再同步化治疗的临床疗效影响  

Influence of left ventricular lead position on clinical outcome of cardiac resynchronization therapy

作　　者：王义龙[1] 李畅[1] 高洁[1] 顾刚[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心血管内科,上海200025

出　　处：《内科理论与实践》2016年第1期20-23,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的 :探讨左心室电极植入左心室侧壁不同部位时是否影响心脏再同步化治疗(CRT)的临床疗效。方法:89例符合CRT植入指征的心力衰竭(心衰)患者,经药物优化治疗3个月以上无效而行CRT植入术,根据术中左前斜X线冠状静脉逆行造影结果将左心室侧壁电极位置分为前侧壁(n=20)、侧壁(n=45)、后侧壁(n=24)3组,分析术后1年纽约心脏病学会(NYHA)心功能分级,心脏超声参数改变量[左心室射血分数(△LVEF)、左心室收缩末内径(△LVESD)、左心室舒张末内径(△LVEDD)],以及心功能分级改善情况和心衰再入院率及全因病死率在各组中的差异。结果:术后1年侧壁与后侧壁组△LVEF、△LVESD、△LVEDD及NYHA心功能分级无统计学差异(均P>0.05),但均优于前侧壁组(均P<0.05);侧壁及后侧壁组心衰再入院率及全因病死率无统计学差异(均P>0.05),但均明显低于前侧壁组(均P<0.05)。结论:CRT左心室电极植入左心室侧壁及后侧壁临床疗效优于前侧壁,提示左心室电极位置影响CRT反应性。Objective To study the influence of left ventricular lead position on clinical outcome among patients receiving cardiac resynchronization therapy（CRT）. Methods A total of 89 patients who were refractory to optimized pharmacologic therapy for 3 months or more and met the indication of CRT implantation were classified into 3 groups according to the left ventricular lead position in retrograde coronary venous angiography left anterior oblique（LAO） view：anterolateral group（n =20）, lateral group（n =45） and posterolateral group（n =24）. After 1 year follow-up, the echocardiographic parameter changes, including left ventricular ejection fraction change（ △LVEF）, left ventricular endsystolic diameter change（△LVESD）, left ventricular end-diastolic diameter change（△LVEDD） and cardiac function classification assessed, as well as all-cause mortality and heart failure hospitalization between the two groups were compared. Results After 1 year follow-up,the value of △LVEF, △LVESD, △LVEDD and NYHA showed no statistical difference between the lateral and posterolateral groups（all P0.05）, but much better than the anterolateral group（all P0.05）. As to the 1 year all-cause mortality and heart failure hospitalization, the lateral and posterolateral group were comparable（all P〉0.05）, but a significantly increased risk was observed in the anterolateral group（all P〈0.05）.Conclusions Left ventricular lead placed in the lateral and posterolateral region were associated with better clinical outcomes when compared with that placed in anterolateral region, suggesting that the left ventricular lead position has an impact on CRT response.

关 键 词：心脏再同步化治疗 左心室电极位置 临床疗效 

分 类 号：R541.6[医药卫生—心血管疾病]