摘要
目的:分析心脏再同步化治疗(CRT)超反应患者的临床特点,探讨影响CRT超反应的预测因素。方法:回顾性收集中国医学科学院阜外医院2014年1月至2019年3月间CRT患者的临床资料并对其进行临床随访。CRT术后6个月NYHA心功能分级改善至Ⅰ级或Ⅱ级且左心室射血分数(LVEF)≥50%定义为CRT超反应。结果:本研究共纳入352例CRT患者,平均年龄为(58.8±11.6)岁,男性237例(67.3%)。随访6个月,共有97例(27.6%)患者表现为CRT超反应。与CRT非超反应患者相比,CRT超反应患者的左心房内径(LAD)和左心室舒张末期内径(LVEDd)较小,LVEF更高,NYHA心功能分级更低,合并高血压比例较高,应用血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)及β受体阻滞剂比例较高。随访6个月,CRT超反应患者较CRT非超反应患者LAD、LVEDd、LVEF以及心功能改善更显著,且术后QRS波时限更窄,双心室起搏比更高。多因素Logistic回归分析显示合并高血压(OR=3.31,95%CI:1.83~5.97,P<0.001)、基线LVEDd(OR=0.94,95%CI:0.90~0.98,P=0.003)、LVEF(OR=1.05,95%CI:1.01~1.10,P=0.042)、NYHA心功能分级(OR=0.47,95%CI:0.28~0.79,P=0.005)、术后QRS波时限(OR=0.98,95%CI:0.96~0.99,P=0.008)以及双心室起搏比(OR=1.13,95%CI:1.05~1.22,P=0.001)均是CRT超反应的独立预测因素。结论:超过1/4的CRT患者表现为超反应,CRT超反应患者左心室机械重构及电重构指标显著改善。合并高血压、基线LVEDd、LVEF、NYHA心功能分级、术后QRS时限以及双心室起搏比均与CRT超反应相关。
Objectives:To analyze and investigate the clinical profiles and predictors of super-responders(SR)to cardiac resynchronization therapy(CRT).Methods:The study included 352 consecutive heart failure patients who underwent CRT at Fuwai Hospital from January 2014 to March 2019.Clinical and echocardiographic evaluations were conducted before and 6 months after CRT implantation.Patients with a decrease in NYHA functional class toⅠorⅡcombined with LVEF≥50%at 6-month follow-up were classified as SR.Results:The mean age of patients in this cohort was(58.8±11.6)years and 237 patients(67.3%)were male.There were 97 SR patients(27.6%).Compared with non-SR patients,SR patients had smaller LAD and LVEDd,higher LVEF and lower grade of NHYA class as well as higher proportion of hypertension and application of ACEI/ARB and beta-blockers.Over a mean follow-up of 6 months,compared with non-SR patients,SR patients were featured with significantly reduced LAD,LVEDd and NHYA class as well as elevated LVEF.Percentage of biventricular pacing was higher,QRS duration was shorter in SR group than in non-SR group.Multivariable logistic regression analysis showed that the comorbidity of hypertension(OR=3.31,95%CI:1.83-5.97,P<0.001),the baseline LVEDd(OR=0.94,95%CI:0.90-0.98,P=0.003),LVEF(OR=1.05,95%CI:1.01-1.10,P=0.042)and NHYA class(OR=0.47,95%CI:0.28-0.79,P=0.005)as well as biventricular pacing(OR=0.98,95%CI:0.96-0.99,P=0.008)and QRS duration after CRT(OR=1.13,95%CI:1.05-1.22,P=0.001)were independent predictors of SR to CRT.Conclusions:More than a quarter of patients who underwent CRT are identified as SR in this cohort.The SR to CRT patients are featured with more significant reverse cardiac remodeling as compared to non-SR patients.The comorbidity of hypertension,the baseline LVEDd,LVEF and NHYA class as well as biventricular pacing and QRS duration after CRT are strongly associated with the SR to CRT.
作者
蔡迟
蔡敏思
华伟
牛红霞
王靖
任晓庆
楚建民
张澍
CAI Chi;CAI Minsi;HUA Wei;NIU Hongxia;WANG Jing;REN Xiaoqing;CHU Jianmin;ZHANG Shu(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第9期886-890,共5页
Chinese Circulation Journal
基金
首都临床特色应用研究与成果推广(Z15110700400000)。
关键词
心脏再同步治疗
超反应
临床特点
预测因素
cardiac resynchronization therapy
super-responders
clinical profiles
predictors
