房室间期优化算法在慢性心力衰竭心脏再同步治疗中的作用评价  

Evaluation of atrioventricular interval optimization algorithm in cardiac resynchronization therapy for chronic heart failure

作　　者：胡凯 陈康玉 王齐 苏浩 严激 Hu Kai;Chen Kangyu;Wang Qi;Su Hao;Yan Ji(Department of Cardiology,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230002,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)心血管内科,合肥230002

出　　处：《中华心律失常学杂志》2023年第4期315-322,共8页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的评估房室间期优化算法(SmartDelay)在慢性心力衰竭(心衰)患者心脏再同步治疗(CRT)中的作用。方法本文为回顾性研究。纳入2020年12月至2022年2月在中国科学技术大学附属第一医院心血管内科植入心脏再同步治疗除颤器(CRT-D)的患者,根据术后实际房室间期优化情况,分为房室间期优化(AVO)组(AVO组,采用SmartDelay算法优化)及固定房室间期组(采用120 ms固定房室间期)。收集患者术后6个月的随访数据,比较两组左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心房内径(LAD)及肺动脉收缩压(SPAP)等参数的变化情况及组间差异。结果纳入75例植入CRT-D患者,其中男59例(78.9%,59/75),年龄69.0(58.5,73.0)岁,年龄范围30~85岁。AVO组42例(56%,42/75),固定房室间期组33例(44%,33/75)。与术前相比,AVO组术后6个月的LVESV[200.5(152.5,240.8)ml对121.0(68.6,180.8)ml,P<0.001]、LVEDV[280.5(225.5,320.0)ml对193.0(144.8,270.0)ml,P<0.001]、LVEF[29.0(22.5,35.0)%对44.9(30.5,54.4)%,P<0.001]及LAD[44.0(41.2,50.8)mm对41.0(39.0,48.8)mm,P=0.001]均差异有统计学意义;固定房室间期组LVESV[205.0(149.0,249.0)ml对144.0(114.0,206.0)ml,P<0.001]、LVEDV[282.0(227.0,342.0)ml对221.0[177.0,366.0]ml,P<0.001]、LVEF[29.0(22.0,33.0)%对33.0(26.0,44.0)%,P<0.001]及LAD[47.0(44.0,54.0)mm对46.0(40.0,52.0)mm,P=0.003]较术前差异有统计学意义。AVO组术后6个月的LVEF明显高于固定房室间期组[44.9(30.5,54.4)%对33.0(26.0,44.0)%,P=0.045],AVO组术后6个月较基线的LVEF改善差值(∆LVEF)显著高于固定房室间期组[10.8(3.5,24.5)%对3.0(0,12.0)%,P=0.034],两组间LVESV较基线的改善差值(∆LVESV)差异无统计学意义[-67.8(-136.3,-10.2)ml对-32.0(-72.0,-10.0)ml,P=0.132],两组CRT反应率差异无统计学意义[66.7%(28/42)对54.5%(18/33),P=0.285]。两组患者术后6个月二尖瓣反流情况差异有统计学意义(P=0.012),但与术前相比的反流级别变化差异无统计学意�Objective To evaluate the potential benefit of SmartDelay programming,an algorithm that used for atrioventricular(AV)optimization,in patients with chronic heart failure after cardiac resynchronization therapy(CRT)implantation.Methods All the patients with cardiac resynchronization therapy defibrillator(CRT-D)implanted between December 2020 to February 2022 were retrospectively enrolled in Department of Cardiology,First Affiliated Hospital of University of Science and Technology of China,who were then involved into either atrioventricular interval optimization(AVO)group(optimized by SmartDelay algorithm)or fixed AV group(fixed atrioventricular interval of 120 ms)based on their AV programming method after the procedure.All the patients were followed up for 6 months after the procedure in order to compare the difference of left ventricular ejection fraction(LVEF),left ventricular end systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left atrial diameter(LAD),pulmonary artery systolic pressure(SPAP)and other parameters between the two groups.Results A total of 75 CRT-D implantation patients were selected,including 59 males(78.9%,59/75),age 69.0(58.5,73.0),age range 30 to 85 years,of whom 42 received SmartDelay optimized AV interval.Compared with the preoperative period,LVESV at 6 months after surgery in the AVO group[200.5(152.5,240.8)ml vs.121.0(68.6,180.8)ml,P<0.001],LVEDV[280.5(225.5,320.0)ml vs.193.0(144.8,270.0)ml,P<0.001],LVEF[29.0(22.5,35.0)%vs.44.9(30.5,54.4)%,P<0.001]and LAD[44.0(41.2,50.8)mm vs.41.0(39.0,48.8)mm,P=0.001]were all significantly improved,LVESV[205.0(149.0,249.0)ml vs.144.0(114.0,206.0)ml,P<0.001],LVEDV[282.0(227.0,342.0)ml vs.221.0(177.0,366.0)ml,P<0.001],LVEF[29.0(22.0,33.0)vs.33.0%(26.0,44.0)%,P<0.001]and LAD[47.0(44.0,54.0)mm vs.46.0(40.0,52.0)mm,P=0.003]also showed significant improvement over preoperative in fixed AV group,LVEF at 6 months in the AVO group than in the fixed AV group(44.9(30.5,54.4)%vs.33.0(26.0,44.0)%,P=0.045).The differential LVEF improvement(LVEF)from

关 键 词：心力衰竭 心脏再同步治疗 房室间期优化 左心室射血分数 左心室收缩末期容积 

分 类 号：R541.6[医药卫生—心血管疾病]