摘要
目的:探讨心力衰竭患者行心脏再同步化治疗(CRT)之前基础资料和术后短期心功能改善程度对长期疗效的预测价值。方法:对50例心力衰竭患者行CRT治疗,以治疗后6个月左室收缩末期容积(LVESV)较术前减小≥15%为治疗有效,分为有效组(32例)和无效组(18例)。对所有患者术前、术后1周及术后6个月行超声心动、QRS时限、脑钠肽(BNP)、心功能分级(NYHA)等检测。结果:50例患者均成功接受CRT。2组术前病因比例、左束支传导阻滞比例、NYHA、左房前后径、肺动脉压、QRS时限、室间机械延迟、左室间隔与后壁运动延迟、BNP等均差异有统计学意义。2组术前与术后1周各指标差值(△)中,△LVESV、△左室射血分数、△QRS时限等差异有统计学意义。多元回归分析显示,△LVESV是预测CRT有效性的保护因素。ROC曲线显示,△LVESV对CRT疗效有预测价值(曲线下面积=0.88,P<0.01),当△LVESV≥11.0 ml时,敏感度和特异度最大,分别为84%和83%;△QRS对CRT疗效也有一定的预测价值(曲线下面积=0.74,P<0.01),当△QRS≥20.0ms时,敏感度和特异度最大,分别为88%和56%。有效组和无效组5年生存率分别为80.0%和61.1%,差异有统计学意义(P=0.036)。结论:术前病情严重程度、心脏机械运动不同步程度及△LVESV、△QRS大小对CRT疗效有一定的预测价值。
Objective：To explore the predictive factors of response in heart failure by cardiac resynchronisation therapy（CRT）.Method：Fifty patients with heart failure received RCT.At least 15% reduction in LVESV at the 6 months after CRT was defined as responders.They were divided into effective group（n=32） and ineffective group（n=18） group.All patients′ electrocardiogram,the duration of QRS wave,BNP and NYHA were examined at baseline,one week and six months after CRT.Result：Pacemakers were successfully implanted in all the 50 patients.The percentage of ischemic cardiomyopathy and CLBBB,NYHA,LAD,PAP,the duration of QRS wave,IVMD,SPWMD and BNP before CRT were significantly different between the two groups.The changes（△） of LVESV,LVEF and QRS before CRT and one week after CRT were significantly different between the two groups.Multivariable Logistic regression analysis showed that △LVESV was an independent positive predictor of response to CRT.ROC curve showed that △LVESV could predict the response to CRT（AUC=0.88,P0.01）.Decrease of 11.0 ml in LVESV could predict response to CRT with a sensitivity of 84% and specificity of 83%.The level of △QRS wave also could predict the response to CRT（AUC=0.74,P0.01）.Decrease of 20.0 ms in QRS could predict response to CRT with a sensitivity of 88% and specificity of 56%.The survival estimates at 5 years was significantly different between the two groups（P=0.036）.Conclusion：The pathogenetic condition,the level of mechanical dyssynchrony,△LVESV and △QRS wave can predict the response in patients with heart failure treated by CRT.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2012年第11期807-810,共4页
Journal of Clinical Cardiology
关键词
心力衰竭
心脏再同步化治疗
心脏超声
疗效
预测
heart failure
cardiac resynchronization therapy
echocardiography
treatment outcome
prediction
