首页|缺血性心肌病患者舒张充盈模式对心脏再同步治疗疗效的影响

缺血性心肌病患者舒张充盈模式对心脏再同步治疗疗效的影响

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目的:探讨缺血性心肌病患者舒张充盈模式对心脏再同步治疗(CRT)疗效的影响。<br>  方法:将2012-03至2014-03于我院接受CRT的61例缺血性心肌病患者,根据术前舒张充盈模式,分为非限制性充盈组(n=36)和限制性充盈组(n=25)。随访12个月,根据美国纽约心脏协会(NYHA)心功能分级,超声心动图检查评估各组CRT疗效。以心力衰竭再入院或心原性死亡为终点事件,绘制生存曲线,评估各组预后。<br>  结果:(1)非限制性充盈组:CRT反应率为66.7%(24/36),高于限制性充盈组的28.0%(7/25)(χ2=8.826, P=0.003);术后NYHA心功能分级,左心室射血分数(LVEF),短轴缩短率(FS),左心室舒张末期容积(LVEDV)及左心室收缩末期容积(LVESV)均显著改善(P均<0.01)。(2)限制性充盈组(n=25):仅出现术后的NYHA心功能分级改善(P<0.01);术后6个月LVEF,FS及LVESV均无显著改善,LVEDV较前增加(P<0.05)。术后6个月两组间疗效差异显著(P<0.01)。多因素Logistic回归分析显示舒张充盈模式是CRT有反应的独立影响因素。随访12个月,2例患者死亡,限制性充盈组累积终点事件发生率76.0%(19/25),高于非限制性充盈组的44.4%(16/36;χ2=5.213,P=0.022)。<br>  结论:舒张充盈模式影响CRT疗效,非限制性充盈模式的缺血性心肌病患者CRT获益显著,限制性充盈模式的患者,CRT反应率低、疗效差、预后不良。
Influence of Diastolic Filling Pattern on Cardiac Resynchronization Therapy in Patients With Ischemic Cardiomyopathy
Objective: To explore the inlfuence of diastolic iflling pattern on cardiac resynchronization therapy (CRT) in patients with ischemic cardiomyopathy. <br> Methods: A total of 61 patients with ischemic cardiomyopathy received CRT in our hospital from 2012-03 to 2014-03 were studied. According to pre-CRT diastolic iflling pattern, the patients were divided into 2 groups:Non-restrictive iflling (NRF) group, n=36 and RF group, n=25. All patients were followed-up for 12 months, based on NYHA classiifcation, CRT efifcacy was assessed by echocardiography;the endpoints included re-hospitalization for heart failure or cardiac death. Kaplan-Meier survival curve was used to assess the prognosis. <br> Results: ①NRF group had CRT response rate at 66.7%(24/36) which was higher than RF group 28.0%(7/25), (χ2=8.826, P=0.003);the post-operative NYHA classiifcation, LVEF, FS, LVEDV and LVESV were signiifcantly improved, all P<0.01.② RF group showed the improved post-operative NYHA classification, P<0.01, while no obvious changes of LVEF, FS, LVEDV at 6 months after operation, and LVESV increased than it was before, P<0.05. Signiifcant differences were observed between 2 groups at 6 months after operation, P<0.01. Logistic regression analysis indicated that diastolic iflling pattern was the independent impact factor for CRT response. There were 2 patients died during 12 months of follow-up period;the endpoints in RF group was 76.0%(19/25) which was higher than NRF group 44.4%(16/36), (χ2=5.213, P=0.022). <br> Conclusion: Diastolic iflling pattern affected CRT efifcacy in patients with ischemic cardiomyopathy;NRF patients were more beneifciary for CRT, while RF patients had lower response to CRT which associated to poor prognosis.

Heart failureCardiac resynchronization therapyEchocardiography, Doppler

王齐、陈康玉、宇霏、苏浩、安春生、胡杨、杨冬妹、徐健、严激

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230001 安徽省合肥市,安徽医科大学附属省立医院 心血管内科

心力衰竭 心脏再同步治疗 超声心动描记术,多普勒

2010年安徽省卫生厅医学科研重点项目安徽省2013年度第三批科技计划项目

2010A0021301042210

2016

中国循环杂志
中国医学科学院

中国循环杂志

CSTPCDCSCD北大核心
影响因子:2.803
ISSN:1000-3614
年,卷(期):2016.31(2)
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