心脏再同步治疗中左右心室电极位置间距离与临床效果分析  

The correlation of the clinical effect with the distance between left and right ventricular electrode positions in cardiac resynchronization therapy

作　　者：肖群林 刘诗文 董薇 张兴 张玉珍 谢明团 段敦柱 彭景添[1] 王梦洪[1] 郑泽琪[1] 吴印生[1] 彭小平[1] XIA O Qunlin, LIU Shiwen, DONG Wei, ZHANG Xing, ZHAN Yuzhen, XIE Mingtuan, DUAN Dunzhu, PENG Jingtian, WANG Menghong, ZHENG Zeqi, WU Yinsheng, PENG Xiaoping(Department of Cardiovascular Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, Chin)

机构地区：[1]南昌大学第一附属医院心血管内科,330006

出　　处：《介入放射学杂志》2018年第4期303-308,共6页Journal of Interventional Radiology

摘　　要：目的探讨左、右心室电极植入位置间距离与心脏再同步化治疗(CRT)临床效果关系。方法选取2010年1月至2017年1月收治的经最佳药物治疗仍存在心力衰竭症状、符合CRT指征的75例心力衰竭患者。采集术前和术后6个月患者左心室射血分数(LVEF)、左心室舒张末内径(LVEDD)、左心房前后径(LAAPD)、QRS波宽、脑钠肽(BNP)、美国纽约心脏病协会(NYHA)心功能分级、6 min步行试验(6MWT)距离、明尼苏达心力衰竭生活质量问卷(MLHFQ)评分以及随访期间全因再入院次数、全因病死例数。游标卡尺精确测量术后CRT影像指标心脏横径(L),正位(DD1)、左前斜位(DD2)、右前斜位(DD3)时左、右心室电极植入位置间直接距离,取直接距离最大值(DD);计算左、右心室电极植入位置间DD/L。根据《心血管系统疗效评价指标》及meta分析疗效评判标准分为显效应答(A组)、有效应答(B组)、无应答(C组)。结果 3组患者CRT术后6个月LVEF、6MWT距离均提高,LVEDD、QRS波宽、BNP、MLHFQ评分均降低,3组间差异均有统计学意义(P<0.05);LAAPD差异无统计学意义(P=0.974)。A组患者与B组患者比较,L差异无统计学意义(P=0.175),DD、DD/L差异均有统计学意义(P=0.001);A组与C组比较,L差异无统计学意义(P=0.225),DD、DD/L差异均有显著统计学意义(P=0.001);B组与C组比较,L差异无统计学意义(P=0.452),DD、DD/L差异均有统计学意义(P=0.032,P=0.010);F检验显示3组患者L差异无统计学意义(P=0.249),DD、DD/L均有显著统计学意义(P=0.001)。多因素Logistic回归分析显示3组DD(P=0.034,OR=0.094,95%CI=-4.546^-0.178)、DD/L(P=0.038,OR=0.088,95%CI=-4.726^-0.137)差异均有统计学意义。结论左、右心室电极植入位置间距离与CRT效果相关,CRT术中左、右心室电极植入位置DD/L越大,相应临床效果越佳,左、右心室电极植入位置间距离是CRT效果独立影响因素。Objective To investigate the relationship between the left-right ventricular electrode distance and clinical curative effect in cardiac resynchronization therapy （CRT）. Methods A total of 75 patients with heart failure which conformed to CRT indications, who were admitted to authors＇ hospital during the period from January 2010 to January 2017 and had received optimal drug therapy, were included in this study. Before CRT and 6 months after CRT, the following items were tested or calculated： left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter （LVEDD）, left atrial anteroposterior diameter （LAAPD）, electrocardiogram QRS wave width, brain natriuretic peptide （BNP）, cardiac function grading by New York Heart Association （NYHA） criteria, 6 minute walking test （6MWT） distance, Minnesota living with heart failure questionnaire （MLHFQ） score, the number of all-cause re-hospitalization and the number of all- cause death during the follow-up period. The following image indexes were precisely measured with vernier caliper： transverse diameter of the heart （L）, the direct distance between left and right ventricular electrode implantation sites （taking the maximum direct distance, DD） on the anteroposterior （DD1）, left anterior oblique （DD2） and right anterior oblique positions （DD3）; the ratio of DD/L was calculated. According to 《Evaluation Index of Curative Effect of Cardiovascular System》 and the results of meta analysis, the criteria of curative effect were defined as significant response （group A）, effective response （group B） and no response （group C）. Results Six months after CRT, the values LVEF and 6MWT were increased and the scores of LVEDD, QRS wave width, BNP and MLHFQ were decreased in all patients of three groups; the differences between each other among the three groups were statistically significant （P〈0.05）. No statistically significant difference in LAAPD existed among the three groups （P=0.974）

关 键 词：心力衰竭 心脏再同步治疗 心室电极距离 疗效 

分 类 号：R541.61[医药卫生—心血管疾病]