CAJ | 학술논문

目的提出新的心脏再同步治疗(CRT)优化算法,并验证其合理性.方法根据心脏电机械偶联原理,将体表心电图和超声心动图指标的数量关系用新公式表述,通过前瞻性随机对照研究比较新算法与现有方法的差异.41例患者随机分为新算法组(21例)及腔内心电图(IEGM)组(20例),每例均分别用新算法、传统超声心动图法及IEGM法优化,即刻比较3种方法的主动脉血流速度时间积分(AVTI)及耗时.然后新算法组采用新算法提供的优化参数,IEGM组采用IEGM法提供的参数并进行远期随访.结果即刻比较:新算法的AVTI优于IEGM法[(22.32±3.48)cm对(19.22±3.07)cm,P＜0.05],新算法耗时较传统超声心动图法减少[(18.80±3.30) min对(203.81±20.12) min,P＜0.01].随访18个月,新算法组左心室射血分数较IEGM组高[(0.37±0.03)对(0.32±0.04),P＜0.05],血浆脑钠肽水平较IEGM组低[(3245.24±644.56) ng/L对(3636.62±560.98) ng/L,P＜0.05],终点事件发生率较IEGM组低(P=0.045).结论新算法用于CRT优化准确、快速,具有合理性及临床推广价值.
목적 제출신적심장재동보치료(CRT)우화산법,병험증기합이성.방법 근거심장전궤계우련원리,장체표심전도화초성심동도지표적수량관계용신공식표술,통과전첨성수궤대조연구비교신산법여현유방법적차이.41례환자수궤분위신산법조(21례)급강내심전도(IEGM)조(20례),매례균분별용신산법、전통초성심동도법급IEGM법우화,즉각비교3충방법적주동맥혈류속도시간적분(AVTI)급모시.연후신산법조채용신산법제공적우화삼수,IEGM조채용IEGM법제공적삼수병진행원기수방.결과 즉각비교:신산법적AVTI우우IEGM법[(22.32±3.48)cm대(19.22±3.07)cm,P＜0.05],신산법모시교전통초성심동도법감소[(18.80±3.30) min대(203.81±20.12) min,P＜0.01].수방18개월,신산법조좌심실사혈분수교IEGM조고[(0.37±0.03)대(0.32±0.04),P＜0.05],혈장뇌납태수평교IEGM조저[(3245.24±644.56) ng/L대(3636.62±560.98) ng/L,P＜0.05],종점사건발생솔교IEGM조저(P=0.045).결론 신산법용우CRT우화준학、쾌속,구유합이성급림상추엄개치.
Objective To propose a new algorithm of quick optimization for cardiac resyncaronization therapy (CRT) by verification of the rationality of the new method.Methods The quantitative relationship between electrocardiographic and echocardiographic parameter was presented by a new formula on the basis of the principle of cardiac electrical mechanical coupling.A new algorithm method was compared with previous methods by a prospective control study comprising 41 patients who were allocated into new algorithm group(n =21) and intracardiac electrogram(IEGM) group (n =20) at random.Every case of CRT optimization accepted new algorithm method,traditional echocardiographic method,and intracardiac IEGM method respectively.Aortic time velocity integrals (AVTI) and operating time were measured to assess the acute hemodynamic effects of each optimization method.Atrioventricular (AV) and interventricular (VV) interval settings recommended by new algorithm were adopted to new algorithm group,and that recommended by IEGM method were adopted to IEGM group.The comparison of heart function in each group was performed by evaluating indices including left ventricular ejection fraction (LVEF) and plasma brain natriuretic peptide (BNP).Associated end-points including stroke,death,and admission due to heart failure were also compared by a survival analysis during a long-term follow-up.Results New algorithm method showed higher AVTI values compared with IEGM method [(22.32±3.48) cm vs (19.22 ± 3.07) cm,P＜ 0.05].Meanwhile,the operating time was obviously reduced by using the new algorithm methodcompared with traditional echocardiographic method [(18.80 ± 3.30) min vs (203.81±20.12) min,P＜0.01].The average BNP in the new algorithm group was lower than that in the IEGM group[(3245.24±644.56) ng/L vs (3636.62±560.98)ng/L,P＜0.05],while the LVEF in the new algorithm group was higher than that in the IEGM group[(0.37±0.03)vs(0.32±0.04),P＜0.05].In a follow-up duration of 18 months,a decreasing tendency of the events of associated end-points in the new algorithm group illustrated by the Kaplan-Meier plot (P =0.045).Conclusion The new algorithm provides a reliable,quick,and simpler clinic alternative to the generalization of CRT optimization.