CAJ | 학술논문

目的探讨心力衰竭患者心脏再同步治疗(CRT)术后的死亡原因及相关影响因素。方法对110例行CRT的心力衰竭患者[其中7例植入带有心脏再同步治疗除颤器(CRT-D)]进行长期随访，观察患者术后的转归情况，以及死亡患者的死亡原因、生存时间和相关影响因素。结果 110例患者中有92例患者完成随访研究，随访1～132（48±28）个月，共死亡30例，死亡率为32.6％，5年生存率为66.9％±5.8％。24例为心脏性死亡，占总体死亡的80％，其中包括11例为心力衰竭恶化导致的死亡，13例为心脏性猝死(sCD)，其余6例为非心脏性死亡。14例行CRT的持续性心房颤动（房颤）患者中有8例死亡；71例行CRT的窦性心律患者中死亡22例；前组的中位生存时间短于后组(50比87，P=0.013)；7例植入CRT-D的患者均无死亡；3组患者的死亡率差异有统计学意义(P=0.01)。合并慢性肾功能衰竭的CRT患者死亡率(66.7％)较无肾功能不良者(20.6％)高(相对危险度：3.24，95％ CI1.88 ～5.59,P＜0.001)。结论 CRT患者的主要死亡原因是心脏性死亡，其中包括心力衰竭恶化和SCD。CRT-D和CRT两组患者之间的死亡率差异有统计学意义，接受CRT的窦性心律患者较持续性房颤患者有显著的生存获益。合并慢性肾功能衰竭的CRT患者预后较差。对于合并持续性房颤的CRT患者同时给予房室结消融有可能进一步提高生存率。
목적 탐토심력쇠갈환자심장재동보치료(CRT)술후적사망원인급상관영향인소。방법 대110례행CRT적심력쇠갈환자[기중7례식입대유심장재동보치료제전기(CRT-D)]진행장기수방，관찰환자술후적전귀정황，이급사망환자적사망원인、생존시간화상관영향인소。결과 110례환자중유92례환자완성수방연구，수방1～132（48±28）개월，공사망30례，사망솔위32.6％，5년생존솔위66.9％±5.8％。24례위심장성사망，점총체사망적80％，기중포괄11례위심력쇠갈악화도치적사망，13례위심장성졸사(sCD)，기여6례위비심장성사망。14례행CRT적지속성심방전동（방전）환자중유8례사망；71례행CRT적두성심률환자중사망22례；전조적중위생존시간단우후조(50비87，P=0.013)；7례식입CRT-D적환자균무사망；3조환자적사망솔차이유통계학의의(P=0.01)。합병만성신공능쇠갈적CRT환자사망솔(66.7％)교무신공능불량자(20.6％)고(상대위험도：3.24，95％ CI1.88 ～5.59,P＜0.001)。결론 CRT환자적주요사망원인시심장성사망，기중포괄심력쇠갈악화화SCD。CRT-D화CRT량조환자지간적사망솔차이유통계학의의，접수CRT적두성심률환자교지속성방전환자유현저적생존획익。합병만성신공능쇠갈적CRT환자예후교차。대우합병지속성방전적CRT환자동시급여방실결소융유가능진일보제고생존솔。
Objective The aim of this study was to explore the cause of and the factors related to death in patients with heart failure (HF) after cardiac resynchronization therapy(CRT). Methods One hundred and ten patients with congestive heart failure treated with CRT were enrolled in this study,including 7 patients underwent CRT+an implantable defibrillator(CRT-D). The postoperative outcome, cause of death, survival time, as well as the factors related to death were observed during the long follow-up. Results The mean follow-up period was 1 ～ 132 (48 ±28 ) months, while 92 patients have completed the follow-up. Thirty patients died ( 32.6％ ),and the 5-year survival rate was 66. 9％ ± 5. 8％. Twenty-four of them ( 80％ ) were cardiac causes ( pump failure = 11, sudden cardiac death = 13 ), and 6 patients due to non-cardiac causes. Eight patients with persistent atrial fibrillation(n= 14) died,22 patients with sinus rhythm (n = 71 ) died, all patients with sinus rhythm who underwent CRT-D ( n = 7) were survival There were significant differences ( P = 0. 01 ) in the mortality among the three groups. The mortality in patents with chronic renal failure (CRF) was higher than those without CRF ( HR: 3.24,95 ％ CI 1.88 ～ 5.59, P ＜ 0. 001 ). Conclusion Cardiac death, including heart pump failure and sudden cardiac death are the predominant causes of death in patients after CRT. Patients with persistent atrial fibrillation or CRF have disadvantage in survival. CRT-D improve survival rate, and atrio-ventricular node ablation in patients with persistent atrial fibrillation may be a way to improve survival rate.