心脏再同步化治疗后心功能恢复正常的预测因素分析  

Predictors for Sustained Normalization of Cardiac Function in Chronic Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

作　　者：李娜[1] 董颖雪[1] 刘飞 李国草[1] Chandran Sadees Clarance 于晓红[1] 张荣峰[1] 王楠[1] 肖宪杰 尹晓盟[1] 夏云龙[1] 高连君[1] LI Na;DONG Yingxue;LIU Fei;LI Guocao;Chandran Sadees Clarance;YU Xiaohong;ZHANG Rongfeng;WANG nan;XIAO Xianjie;YIN Xiaomeng;XIA Yunlong;GAO Lianjun(Center of Arrhythmia, The First Affiliated Hospital of Dalian Medical University, Dalian (116011), Liaoning, Chin)

机构地区：[1]大连医科大学附属第一医院心律失常中心

出　　处：《中国循环杂志》2019年第8期783-789,共7页Chinese Circulation Journal

基　　金：辽宁省自然科学基金(20170540258)

摘　　要：目的:探讨心脏再同步化治疗(CRT)术后患者心功能恢复正常的预测因素。方法:连续入选2013年1月至2016年9月因慢性心力衰竭接受CRT的患者65例,CRT后心功能恢复正常患者6例(9.23%),CRT有应答患者44例(67.69%)。评价患者的临床特征包括合并疾病情况、心电图包括左束支阻滞形态特征、电极位置及电极间距等。随访(37.4±17.6)个月,并于术前及术后每6个月对其进行临床、起搏器程控以及心脏超声等指标进行随访。结果:CRT后心功能恢复正常患者心力衰竭病史短、心电图表现为真性左束支阻滞、左心房增大程度较轻、右心室电极位于非心尖部、且术后QRS缩短明显(P<0.05)。真性完全性左束支阻滞是CRT后心功能恢复正常的预测OR=12.452,95%CI:3.235~36.682,P=0.012)。真性完全性左束支阻滞患者共12例,其中5例患者心功能恢复正常,发生率41.7%。CRT后6个月,合并真性完全性左束支传导阻滞的患者与非真性完全性左束支传导阻滞者比较,左室射血分数提高[(15.50±13.45)%vs(4.19±3.34)%]及QRS时限缩短[(28.15±19.17)msvs(11.92±4.03)ms)更显著(P均<0.05)。平均随访(37.4±17.6)个月时,真性完全性左束支阻滞患者的死亡率低于非真性完全性左束支阻滞患者(0%vs23.7%,P=0.030)。结论:真性完全性左束支阻滞是CRT术后心功能恢复正常最强的预测因子。Objectives:We aimed to identify the potential predictors for recovery of heart function after cardiac resynchronization therapy(CRT) in patients with chronic heart failure.Methods:This study enrolled consecutive patients with chronic heart failure,hospitalized in our hospital from 2013 to 2016 and underwent CRT.All patients were followed up regularly after CRT.Clinical characteristic of patients including the comorbidities,morphological characteristics of left bundle branch block,position and interface between two electrodes were analyzed.Results:65 consecutive patients(23 females,35.4%) were included in our study.During a follow-up period of(37.4±17.6)months,a total of 44 patients responded well to CRT and six patients(9.23%) recovered to a normal cardiac function after CRT.The disease history was shorter,patients mostly presented had true LBBB and less left atrial enlargement,the position of right ventricular electrode was not placed at apical area,and there was a significant narrowing of QRS post CRT in these 6 patients.There were 12 patients with true LBBB in this cohort and cardiac function was normalized in 5 patients(41.7%).At6 months post CRT,left ejection fraction increased(15.50±13.45)% in patients with true LBBB and(4.19±3.34)% in patients with false LBBB(P<0.05),QRS width narrowed(28.15±19.17) ms in true LBBB patients and(11.92±4.03)ms in false LBBB patients.Our study showed that true LBBB was an independent predictor of the complete recovery of heart function after CRT(OR=12.452,95%CI:3.235-36.682,P=0.012).Compared with patients with false LBBB,patients with true LBBB showed a more significant improvement in cardiac function(83.3% vs 11.9%,P<0.05).The mortality rate in patients with true LBBB was also significantly lower in patients with true LBBB than in patients with false LBBB(0% vs 23.7%,P=0.030).Conclusions:True left bundle branch block is an independent predictor for the complete recovery of cardiac function in chronic heart failure patients after CRT.

关 键 词：心脏再同步化治疗 预测因素 左束支阻滞 

分 类 号：R54[医药卫生—心血管疾病]