V1导联R/S比值预测心脏再同步化治疗效果的价值  

Value of R/S ratio in ECG lead V1 in predicting the effect of cardiac resynchronization therapy

作　　者：吴颖 胡立群 李红旗 宇霏 严激 WU Ying, HU Liqun ,LI Hongqi, YU Fei, YAN Ji(Department of Geriatric Cardiology,Provincial Hospital Affiliated to Anhui Medical University, Hefei, 230001, Chin)

机构地区：[1]安徽医科大学附属省立医院老年心血管内科,合肥230001

出　　处：《临床心血管病杂志》2018年第3期254-258,共5页Journal of Clinical Cardiology

基　　金：安徽省公益性研究联动计划项目(No:1604f0804009)

摘　　要：目的:研究术后首次心电图中V1导联R/S比值预测心脏再同步化治疗(CRT)效果的价值。方法:回顾性分析2015-2017年安徽省立医院接受CRT除颤仪(CRT-D)、CRT起搏器(CRT-P)治疗的62例心力衰竭(心衰)患者,并分为CRT有反应组(39例)和CRT无反应组(23例)。对患者基线资料及术后6个月时的临床资料、心电图、超声心动图结果进行回顾分析。如左室射血分数(LVEF)在CRT术后6个月较术前增加≥5%,则定义为CRT有反应。术后首次心电图中V1导联R/S比值≥1或Ⅰ导联R/S比值≤1定义为R/S比值阳性。结果:(1)基线资料比较:CRT有反应组的女性和左束支传导阻滞(LBBB)比例明显高于无反应组(P=0.014、P=0.04);CRT有反应组患者的平均左心室舒张末期容积(LVEDD)和肺动脉高压(SPAP)均较CRT无反应组低(P<0.01)。(2)随访结果比较:CRT有反应组在术后6个月时的NYHA心功能分级、P波时限、QRS波时限、LVEDD、SPAP均较术前明显改善(均P<0.05);CRT有反应组中术后R/S比值阳性者31例(79.5%),CRT无反应组中术后R/S比值阴性者12例(52.2%)(χ~2=6.637,P=0.01);在42例R/S比值阳性者中LVEF改善率平均为11.78%,而20例R/S比值阴性者中LVEF的改善率为4.31%,差异有统计学意义(P<0.05)。(3)各因素对CRT反应的预测价值:术后心电图中R/S比值阳性(OR=4.43,95%CI:1.06～18.5,P=0.041)是CRT有反应的独立预测因素。结论:CRT术后首次心电图中V1导联R/S比值≥1或Ⅰ导联R/S比值≤1提示左心室的有效起搏,可作为一种经济有效的简单方法预测CRT疗效。Objective： To evaluate the value of R/S ratio on lead V1 in the first electrocardiogram to predict cardiac resynchronization therapy （CRT）. Method： This study retrospectively analyzed 62 patients with heart failure who received CRT and enrolled in the Department of Cardiology, Anhui Provincial Hospital from 2015 to 2017.Patients were divided into CRT responder group （n= 39） and CRT non-responder group （n= 23）. The baseline and follow-up of 6 months of general clinical data, ECG and echocardiographic results were analyzed. The left ventricular ejection fraction （LVEF） increasing≥5 % was defined as CRT response. R/S ratio≥1 in V1 or R/S ratio≤1 in lead I was defined as positive in the first ECG after CRT. Result： （1） Baseline data comparison of the two groups： the proportion of female and LBBB in responder group was significantly higher than that in non-responder group （P=0. 014）. The level of serum N-terminal B-type brain natriuretic peptide （NT-proBNP） was significantly higher in non-responder group（P〈0. 01） ,while the left ventricular end diastolic volume （LVEDD） and pulmonary hypertension （SPAP） were lower（P〈0.01） in the responder group. （2）Comparison of follow-up results between two groups： NYHA heart function level, P wave duration, QRS duration, LVEDD and SPAP were significantly improved in responder group（P〈0.05）. There were 31 cases （79.5 %） of positive R/S ratio in responder group and 12 cases （52.2%） in non-response groupQ（2 =6. 637, P=0.01）. In 42 cases with positive R/S ratio, the average LVEF was improved to 11.78% while the rate in 20 cases with negative R/S ratio was 4.31%（P〈0.05）. （3）Predicting value：The positive rate of R/S ratio was found to be a independent predictor of CRT response（OR= 4.43, 95%CI：1.06-18.50,P= 0. 041）. Conelusion：R/S ratio≥1 in V1 or R/S ratio≤1 in lead I indicates the effective pacing of left ventricle after CRT, which can be used as a kind of cost-effective and simpl

关 键 词：心力衰竭 心脏再同步化 R/S比值 

分 类 号：R541.6[医药卫生—心血管疾病]