心脏再同步化治疗宽QRS波慢性心力衰竭出现超反应的影响因素及预后  

Effect Factors and Prognosis of Superreaction in the Treatment of Chronic Heart Failure with Wide QRS Wave Treated with Cardiac Resynchronization Therapy

作　　者：鄞诚光 梁翠[1] 张彦周[1] YIN Chengguang;LIANG Cui;ZHANG Yanzhou(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,河南郑州450052

出　　处：《河南医学研究》2021年第10期1758-1762,共5页Henan Medical Research

摘　　要：目的探讨心脏再同步化治疗(CRT)宽QRS波慢性心力衰竭(CHF)出现超反应的影响因素及预后。方法回顾性分析2016年1月至2019年12月于郑州大学第一附属医院接受CRT的106例宽QRS波CHF患者的临床资料。将出院6个月随访过程中左室射血分数(LVEF)绝对值增加≥15%且纽约心脏病协会(NYHA)心功能分级改善≥1级的患者纳入超反应组,不符合上述标准的患者被纳入非超反应组。比较两组术前和术后6个月LVEF、左心室舒张末期内径(LVEDD)、NYHA心功能分级、二尖瓣反流(MR)分级等。使用logistic回归模型分析CRT超反应的影响因素。使用受试者工作特征(ROC)曲线评价与超反应发生相关的因子的预测价值。随访6~57个月,比较两组主要终点事件的差异。结果最终纳入106例患者,其中超反应组45例,非超反应组61例。与术前比较,两组术后6个月LVEF增加,LVEDD变小,MR≥2级占比和NYHA分级降低(P<0.05);术后6个月,与非超反应组比较,超反应组LVEF较大,LVEDD较小,MR≥2级占比和NYHA分级较低(P<0.05)。真性左束支传导阻滞(t-LBBB)(OR=6.904,95%CI:1.895~25.155)、较大的QRS波时限差(OR=1.095,95%CI:1.045~1.147)以及较低的基线肺动脉收缩压(PASP)(OR=0.931,95%CI:0.880~0.984)是CRT超反应的独立预测因子(P<0.05)。PASP、QRS波时限差及两者联合预测CRT超反应的ROC曲线下面积分别为0.769、0.814、0.858。PASP≤26.5 mmHg或QRS波时限差≥39.5 ms对预测CRT超反应的发生有一定价值,两者联合检测时预测效能更高(P<0.05)。超反应组主要终点事件发生率低于非超反应组(P<0.05)。结论针对宽QRS波CHF患者,CRT超反应能够减轻MR,逆转左心室重塑,改善心功能及预后。t-LBBB、较大的QRS波时限差以及较低的基线PASP可以预测CRT超反应。PASP≤26.5 mmHg或QRS波时限差≥39.5 ms对预测CRT超反应的发生有一定价值,两者联合检测时预测效果更佳。Objective To explore the effect factors and prognosis of superreaction in the patients with chronic heart(CHF)failure with wide QRS wave treated by cardiac resynchronization therapy(CRT).Methods The clinical data of 106 patients with CHF with wide QRS wave who received CRT in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were analyzed retrospectively.Patients whose absolute value of increased left ventricular ejection fraction(LVEF)was greater than or equal to 15%and cardiac function grade of New York Heart Association(NYHA)was improved with greater than or equal to 1 grade during 6-month follow-up were included in superreaction group,and those who did not meet the above criteria were included in non-superreaction group.LVEF,left ventricular end-diastolic diameter(LVEDD),NYHA cardiac function grade,grade of mitral regurgitation(MR)were compared between the two groups before and 6 months after operation.Logistic regression model was used to analyze the predictors of CRT superreaction.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the factors related to the occurrence of superreaction.The patients were followed up for 6 to 57 months,and the differences of main endpoint events between the two groups were compared.Results Finally,106 patients were included,including 45 cases in superreaction group and 61 cases in non-superreaction group.Compared with those before operation,LVEF increased and LVEDD decreased,and the proportion of MR with the grade greater than or equal to 2 and NYHA grade decreased in the two groups 6 months after operation(P<0.05).LVEF was larger,and LVEDD was smaller,and the proportion of MR with the grade greater than or equal to 2 and NYHA grade were lower in superreaction group than those in non-superreaction group 6 months after operation(P<0.05).True left bundle branch block(t-LBBB)(OR=6.904,95%CI:1.895 to 25.155),larger QRS wave duration difference(OR=1.095,95%CI:1.045 to 1.147)and lower baseline pulmonary art

关 键 词：慢性心力衰竭 心脏再同步化治疗 超反应 预测因素 预后 

分 类 号：R541.7[医药卫生—心血管疾病]