心脏再同步化治疗超反应患者特征分析
发布时间：2018-10-29 14:56
【摘要】：目的:心脏再同步化治疗(CRT)可使心脏收缩失同步心力衰竭(心衰)患者得到临床获益,即有反应,获益明显者心功能明显改善即超反应。然而,即使符合当前指南推荐的患者,CRT植入后约三分之一的患者是“无反应者”。因CRT价格昂贵,所以在医疗资源有限的前提下,如何在术前通过有效的预测指标筛选出更可能出现超反应的患者尤为重要。本研究通过对于天津市胸科医院住院并接受CRT的心衰患者的一般特征、合并疾病、心电图、超声结果等各项相关指标的基线、围手术期和随访期间内数据进行回顾性分析,探讨超反应患者的可能预测因素。方法:入选自2013年3月至2015年1月于天津市胸科医院住院并行CRT的心衰患者。所有患者均置入CRT,通过电子病历系统或纸质病例查询所有患者基线及围术期数据,包括年龄、性别、心衰病程、心电图(术前和术后即刻)、心脏超声、药物治疗情况和伴随疾病(包括扩张性心肌病、缺血性心肌病、高血压、糖尿病、心房颤动)。出院后3个月、6个月、12个月起搏器门诊随访,此后,无症状患者每年随访一次。随访时评估患者近期NYHA分级,询问有无心衰加重所致再入院等心源性事件,记录心电图、心脏超声检查和起搏器参数程控以及指导调整合理抗慢性心衰和抗心律失常药物治疗方案。超反应定义为术后12个月随访过程中出现NYHA分级下降≥1级并且LVEF绝对值增加≥15%;心功能级别无降低或LVEF绝对值增加15%为非超反应。结果:研究共入选心衰患者80例,年龄41-80(62.2±9)岁,其中男性59例(73.75%)。随访12个月期间,有26名(32.5%)患者对CRT出现超反应。超反应组的心衰病程显著短于非超反应组(34.85±42.03月vs.60.76±65.08月,P=0.036),女性比例显著高于非超反应组(42.0%vs.18.5%,P=0.024)。真LBBB的比例显著高于非超反应组(73.1.0%vs.44.4%,P=0.016)。因非缺血性心肌病所致心衰的比例显著高于非超反应组(88.5%vs.64.8%,P=0.027)。基线肺动脉收缩压(PASP)(36.08±10.04mmHg vs.42.72±10.22 mm Hg,P=0.008),左心房内径(LAD)(43.12±6.15 vs.46.50±7.16mm,P=0.042)和左室舒张末期内径(LVEDD)(70.12±9.36mm vs.75.24±10.18mm,P=0.034)同样对CRT术后超反应的发生具有预测价值。此外,超反应组术后QRS波时限显著短于非超反应组(135.15±14.64ms vs.149.89±17.96ms,P0.001)。其他参数在两组中比较差异无显著统计学意义。此外,所有发生心源性事件不良预后的患者均来自非超反应组。使用Kaplan-Meier生存曲线对所有患者不良心血管事件进行分析,Log Rank方法比较结果显示超反应患者的心源性死亡事件和心衰再入院等心源性事件的发生率显著低于非超反应患者(P=0.001)。结论:女性、非缺血性心肌病、合并真LBBB、术后QRS波时限更短、基线PASP正常、左心房和左心室扩张程度更小,心衰病程更短等因素可能与CRT置入术后超反应的发生相关。
[Abstract]:Objective: cardiac resynchronization therapy (CRT) can benefit the patients with cardiac dyssynchrony heart failure (CHF). However, even in accordance with the current guidelines, about 1/3 of patients with CRT implantation are non-responders. Because of the high price of CRT, it is very important to screen out the patients who are more likely to overreact before operation under the premise of limited medical resources. This study analyzed retrospectively the general characteristics of patients with heart failure (HF) who were hospitalized and accepted CRT in Tianjin chest Hospital, the baseline of associated diseases, electrocardiogram and ultrasound results, and the data during perioperative period and follow-up period. To explore the possible predictive factors in patients with hyperactivity. Methods: from March 2013 to January 2015, patients with CRT were admitted to Tianjin chest Hospital. All patients were placed in CRT, to inquire about baseline and perioperative data of all patients, including age, sex, course of heart failure, electrocardiogram (pre-and post-operation), echocardiography, and so on. Drug therapy and associated diseases (including dilated cardiomyopathy, ischemic cardiomyopathy, hypertension, diabetes, atrial fibrillation). Pacemakers were followed up 3 months, 6 months and 12 months after discharge, and asymptomatic patients were followed up once a year. At the follow-up, the patients were evaluated for the recent NYHA grade, asked if there were cardiac events such as readmission due to the exacerbation of heart failure, and electrocardiogram was recorded. Echocardiography and program control of pacemaker parameters, as well as guiding the adjustment of rational anti-chronic heart failure and antiarrhythmic drug treatment. Superreaction was defined as the decrease of NYHA grade 鈮，
本文编号：2298017
[Abstract]:Objective: cardiac resynchronization therapy (CRT) can benefit the patients with cardiac dyssynchrony heart failure (CHF). However, even in accordance with the current guidelines, about 1/3 of patients with CRT implantation are non-responders. Because of the high price of CRT, it is very important to screen out the patients who are more likely to overreact before operation under the premise of limited medical resources. This study analyzed retrospectively the general characteristics of patients with heart failure (HF) who were hospitalized and accepted CRT in Tianjin chest Hospital, the baseline of associated diseases, electrocardiogram and ultrasound results, and the data during perioperative period and follow-up period. To explore the possible predictive factors in patients with hyperactivity. Methods: from March 2013 to January 2015, patients with CRT were admitted to Tianjin chest Hospital. All patients were placed in CRT, to inquire about baseline and perioperative data of all patients, including age, sex, course of heart failure, electrocardiogram (pre-and post-operation), echocardiography, and so on. Drug therapy and associated diseases (including dilated cardiomyopathy, ischemic cardiomyopathy, hypertension, diabetes, atrial fibrillation). Pacemakers were followed up 3 months, 6 months and 12 months after discharge, and asymptomatic patients were followed up once a year. At the follow-up, the patients were evaluated for the recent NYHA grade, asked if there were cardiac events such as readmission due to the exacerbation of heart failure, and electrocardiogram was recorded. Echocardiography and program control of pacemaker parameters, as well as guiding the adjustment of rational anti-chronic heart failure and antiarrhythmic drug treatment. Superreaction was defined as the decrease of NYHA grade 鈮，
本文编号：2298017
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