CAJ | 학술논문

目的探讨双心室再同步化治疗(CRT)心力衰竭患者超应答反应及预测因素.方法 2001年3月至2012年3月分别在白求恩国际和平医院、沈阳军区总医院、解放军二五一医院住院行CRT的心力衰竭患者190例,男145例,女45例,平均年龄(60.5±11.9)岁,其中缺血性心肌病54例,非缺血性心肌病136例,随访6个月～11年(平均58个月).结果 190例患者中10例在术后6个月内死亡,180例完成6个月以上的随访,其中超应答51例(28.33％),应答75例(41.67％),无应答29例(16.11％),负应答25例(13.89％).超应答患者多见于非缺血性心肌病,而负应答患者多见于缺血性心肌病(P＜0.05)；负应答患者血清肌酐水平明显增高(P＜0.05)；无应答及负应答患者肺动脉压力比超应答患者平均高10 mm Hg(1 nm Hg=0.133 kPa,P＜0.05)；超应答患者术前平均QRS波时限≥160ms,术后平均减少30 ms,而负应答患者术前平均QRS波时限139 ms,术后平均减少8 ms,两者差异有统计学意义(P＜0.05).超应答患者左心室电极的位置多在心中部或心底部,而负应答患者左心室电极的位置多在心尖部,两者差异有统计学意义(P＜0.01).结论 CRT超应答与左心室电极置入的部位明显相关,超应答左心室电极的最佳部位是心脏中部和底部,QRS波时限≥160 ms超应答发生率明显增高.
목적 탐토쌍심실재동보화치료(CRT)심력쇠갈환자초응답반응급예측인소.방법 2001년3월지2012년3월분별재백구은국제화평의원、침양군구총의원、해방군이오일의원주원행CRT적심력쇠갈환자190례,남145례,녀45례,평균년령(60.5±11.9)세,기중결혈성심기병54례,비결혈성심기병136례,수방6개월～11년(평균58개월).결과 190례환자중10례재술후6개월내사망,180례완성6개월이상적수방,기중초응답51례(28.33％),응답75례(41.67％),무응답29례(16.11％),부응답25례(13.89％).초응답환자다견우비결혈성심기병,이부응답환자다견우결혈성심기병(P＜0.05)；부응답환자혈청기항수평명현증고(P＜0.05)；무응답급부응답환자폐동맥압력비초응답환자평균고10 mm Hg(1 nm Hg=0.133 kPa,P＜0.05)；초응답환자술전평균QRS파시한≥160ms,술후평균감소30 ms,이부응답환자술전평균QRS파시한139 ms,술후평균감소8 ms,량자차이유통계학의의(P＜0.05).초응답환자좌심실전겁적위치다재심중부혹심저부,이부응답환자좌심실전겁적위치다재심첨부,량자차이유통계학의의(P＜0.01).결론 CRT초응답여좌심실전겁치입적부위명현상관,초응답좌심실전겁적최가부위시심장중부화저부,QRS파시한≥160 ms초응답발생솔명현증고.
Objective To evaluate the incidence of super-response and the potential predictors related to super-response after cardiac resynchronization therapy (CRT)in patients with congestive heart failure.Methods 190 patients [145 men and45 women;age:(60.48 ±11.91) years] underwent CRT between March 2001 and March 2012 were enrolled in this multi-center trial,of which,54 patients with ischemic cardiomyopathy and 136 patients with non-ischemic cardiomyopathy.These patients were followed up from 6 months to 11 years (mean 58 months) post CRT.Results Ten patients died within 6 months post CRT,the others were followed up for more than 6 months.At 6-month follow-up,51 patients were identified as CRT super-responders (28.33％),75 patients were CRT responders (41.67％) and 29 patients were CRT non-responders (16.11％),and 25 patients were CRT negative responders (13.89％).Super-response occurred more frequently in non-ischemic cardiomyopathy patients,while non-response most commonly occurred in ischemic cardiomyopathy patients (P ＜ 0.05) ; patients in the negative response group had higher serum creatinine level than other groups (P ＜ 0.05),and patients in the non-response group and negative response group had higher pulmonary artery pressure than patients in the super-response group(P ＜0.05) ;the average QRS duration was ≥160 ms before CRT,and the mean decrease was around 30 ms after CRT in the super-response group while the average QRS duration was 139 ms before CRT,and the mean reduction was around 8 ms after CRT in the negative response group (P ＜ 0.05).LV lead position in the super-response group was usually in the middle and base of the heart,while in the negative response group it was more commonly located in the apex of the heart (P ＜ 0.01).Conclusions LV lead located at the middle and pre-CRT ORS duration ≥ 160 ms are associated with super-response post CRT procedure in this patient cohort.