【作者】 李娜；

【导师】 董颖雪；

【作者基本信息】 大连医科大学 ， 内科学， 2017， 硕士

【摘要】 目的:分析心脏再同步化治疗(cardiac resynchronization therapy,CRT)后心功能恢复正常患者的临床特征,寻找CRT术后心功能恢复正常的潜在预测因素。方法:连续入选大连医科大学附属第一医院心律失常科2008年1月至2016年9月CRT/CRT-D多合并有左束支传导阻滞的慢性心力衰竭患者70例;对其性别、年龄、身体质量指数、血肌酐、合并疾病情况、心衰持续时间、心衰相关生化指标、心电图特点、超声指标、双室间电极距离及双室电极位置等资料采用回顾性研究,至少随访半年。收集患者植入CRT\CRT-D术前心电图、植入后即刻及随访过程中心电图,评价左束支形态特征及术前、术后QRS时限变化,记录患者合并疾病情况和用药治疗情况。所有患者在植入CRT\CRT-D术前及术后至少6个月分别接受标准的超声心动图检查,测量左心室舒张末内径(LVEDD)、左房内径及左室射血分数(LVEF),评价左心室容积和左室收缩功能,并分别评价NYHA心功能分级。使用SPSS 21.0统计软件对患者资料进行分析。P<0.05认为差异有统计学意义。结果:随访至少6个月后,在所有研究对象中,经CRT治疗后心功能恢复正常组患者8例,心功能未恢复正常组62例,对CRT有应答患者47例,心功能恢复正常患者占所入选患者的11.4%,占CRT治疗后有应答患者的17.0%。CRT治疗后心功能正常组与心功能未恢复正常组患者的基线指标中,前者真性左束支比例显著高于后者,(87.5%vs12.9%,P<0.001),且对CRT预后存在预测价值(OR=12.396,95%CI3.106-36.595,P=0.006);其余指标未见统计学意义。在所有有应答患者中,心功能恢复正常的患者与心功能未恢复正常的患者基线资料中,前者真性左束支比例仍显著高于后者,(87.5%vs12.9%,P<0.001),且对CRT预后存在预测价值(OR=14.383,95%CI2.150～24.856,P=0.012),其余指标未见统计学意义。心功能恢复正常组在CRT植入6个月后,LVEF(30.9±6.8%vs 55.6±3.8%)、LVEDD(61.5±5.6mmvs48.1±3.8mm)、QRS 波时限(172.5±15.7ms vs 141.5±19.0ms)及心功能分级(3.1±0.6vs1.0±0.0)方面较基线状态均有明显改善(P均<0.05)。在所有研究对象中,合并真性左束支的患者与非真性左束支者比较,LVEF 的变化(17.07±13.327 vs 4.22±3.279)、QRS 时限的差值(24.67±10.186 vs11.09±5.682)及 LVEDD 变化(10.71±7.350vs3.60±1.874)较基线状态均有明显改善(P均<0.05);且合并真性左束支者生存率更高,差异有统计学意义(P=0.024)。结论:合并真性左束支传导阻滞的患者,在CRT植入后存在更好的预后。更多还原

【Abstract】 Objective:To analyze the clinical features of returning normal cardiac-function after cardiac resynchronization therapy(CRT/CRT-D)in patients with heart failure.To evaluate the predictors of returning normal cardiac-function after CRT.Methods:A total numbers of 70 patients who underwent CRT/CRT-D were studied since Jan 2008 to Sep 2016 and were divided into three groups:normal cardiac-function group,abnormal cardiac-function group and reaction group.We had collected the information on patients’ baseline date like age,sex,the application of drugs related heart failure,the position of left and right ventricular lead,distance between them and so on,followed up for at least 6 months.Before CRT and 6 months later,clinical and echocardiographic evaluation was performed,left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were measured to evaluate the size and ability of ejection of the left ventricle.Data was analyzed with SPSS 21.0.When P<0.05,the difference was considered to be significant.Results:After follow-up for at least 6 months,8 patients were classified as returning normal cardiac-function after CRT.There was significant difference in true complete left bundle branch block(t-CLBBB)between normal cardiac-function group and abnormal cardiac-function group(87.5%vsl2.9%,OR=12.396,95%CI 3.106～36.595,P=0.006).There was also significant difference in true complete left bundle branch block(t-CLBBB)between normal cardiac-function group and reaction group(87.5%vsl2.9%,OR=14.383,95%CI 2.150～24.856,P=0.012).After 6 months,there were significant changes in LVEF(30.9±6.8%vs 55.6 ± 3.8%),LVEDD(61.5±5.6mm vs 48.1 ±3.8mm),QRS duration(172.5±15.7ms vs 141.5± 19.0ms)and NYHA class(3.1±0.6vs1.0±0.0)in normal cardiac function group.There were also significant changes in LVEF,QRS duration and the improvement of left ventricular end-diastolic diameter(LVEDD){(17.07±13.327 vs 4.22±3.279);(24.670±10.186 vs 11.090±5.682);(10.71±7.350 vs 3.60±1.874);P<0.05}between patients with t-CLBBB)and patients with non-t-CLBBB}.The patients with t-CLBBB have a higher survival rate(P=0.024).Conclusions:A chronic heart failure patient with true left bundle branch block is the predictor of normal cardiac-function after CRT.更多还原