CRT术后极短期心功能改变与中长期反应性的相关性
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摘要
目的通过复查心脏再同步化治疗(cardiac resynchronization therapy,CRT)术后极短期内的心脏超声,评估双心室同步起搏的效果以及与CRT术后中长期反应的相关性。方法收集行CRT-P/D,术后平均5 d内(简称术后)复查了心脏彩超、心电图、脑钠尿肽前体(pro-BNP)等相关检查,且完成起搏器门诊首次随访(随访1,平均术后2个月)和二次随访(随访2,平均术后6个月),包括心脏彩超、心电图等辅助检查的18例患者。结果 18例入选患者平均随访6个月时,4例(22%)为超反应,7例(39%)为无反应,11例(61%)为有反应(包括超反应)。CRT有反应和无反应组在性别、年龄、扩心病、心脏大小和心功能等方面均无统计学差异CRT有反应组术后左室射血分数(LVEF)与术前、随访1和随访2的LVEF均有显著差异(P<0.05或P<0.01);而无反应组以上均无统计学差异。相关分析提示术后LVEF与随访1和随访2的LVEF值显著正相关,与体质量指数(BMI)呈负相关(均P<0.05)。结论术后极短期心功能LVEF值的变化与CRT术后中长期的反应性可能相关。
AIM To evaluate whether echocardiography results, after cardiac resynchronization therapy(CRT) implantation for 5 days, can estimate the effects of biventricular pacing and correlate with mid-long term responsiveness of CRT. METHODS The present investigation evaluated 18 patients who received CRT-P/D implantation and received echocardiography(Echo), 12-leads surface electracardiogram(ECG), Pro-BNP and other evaluations before implantation and 5 days after procedure(post-implantation). Patients were seen in clinic at the first visit(visit 1, 2 months after CRT) and the second visit(visit 2, 6 months after CRT). RESULTS Among all patients, 11 were responders, including 4 super-responders, and 7 were the non-responders. There was no significant difference in sex, age, DCM, heart size, and heart function between the two groups. There was significant difference between post-EF and pre-EF/visit 1 and EF/visit 2 EF in the responder group(all P<0.05); however, there was no significant difference observed between the above parameters in the non-responder group. Correlation analysis showed that LVEF of post-implantation was positively correlated to LVEF of visit 1 and visit 2, and negatively to BMI(all P<0.05). CONCLUSION The change of post-LVEF correlated with the mid-long term CRT response.
AIM To evaluate whether echocardiography results, after cardiac resynchronization therapy(CRT) implantation for 5 days, can estimate the effects of biventricular pacing and correlate with mid-long term responsiveness of CRT. METHODS The present investigation evaluated 18 patients who received CRT-P/D implantation and received echocardiography(Echo), 12-leads surface electracardiogram(ECG), Pro-BNP and other evaluations before implantation and 5 days after procedure(post-implantation). Patients were seen in clinic at the first visit(visit 1, 2 months after CRT) and the second visit(visit 2, 6 months after CRT). RESULTS Among all patients, 11 were responders, including 4 super-responders, and 7 were the non-responders. There was no significant difference in sex, age, DCM, heart size, and heart function between the two groups. There was significant difference between post-EF and pre-EF/visit 1 and EF/visit 2 EF in the responder group(all P<0.05); however, there was no significant difference observed between the above parameters in the non-responder group. Correlation analysis showed that LVEF of post-implantation was positively correlated to LVEF of visit 1 and visit 2, and negatively to BMI(all P<0.05). CONCLUSION The change of post-LVEF correlated with the mid-long term CRT response.
引文
[1] Ponikowski P,Voors AA,Anker SD,et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC[J].Eur Heart J,2016,37(27):2129-2200.
[2] van Bommel RJ,Bax JJ,Abraham WT,et al.Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy:a PROSPECT (Predictors of Response to CRT) sub-analysis[J].Eur Heart J,2009,30(20):2470-2477.
[3] Franke J,Keppler J,Abadei AK,et al.Long-term outcome of patients with and without super-response to CRT-D[J].Clin Res Cardiol,2016,105(4):341-348.
[4] Pires LA,Abraham WT,Young JB,et al.Clinical predictors and timing of New York Heart Association class improvement with cardiac resynchronization therapy in patients with advanced chronic heart failure:Results from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE-ICD) trials[J].Am Heart J,2006,151(4):837-843.
[5] Diaz-Infante E,Mont L,Leal J,et al.Predictors of lack of response to resynchronization therapy[J].Am J Cardiol,2005,95(12):1436-1440.
[6] Yin FH,Fan CL,Guo YY,et al.The impact of gender difference on clinical and echocardiographic outcomes in patients with heart failure after cardiac resynchronization therapy:A systematic review and meta-analysis[J].PLoS One,2017,12(4):e0176248.
[2] van Bommel RJ,Bax JJ,Abraham WT,et al.Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy:a PROSPECT (Predictors of Response to CRT) sub-analysis[J].Eur Heart J,2009,30(20):2470-2477.
[3] Franke J,Keppler J,Abadei AK,et al.Long-term outcome of patients with and without super-response to CRT-D[J].Clin Res Cardiol,2016,105(4):341-348.
[4] Pires LA,Abraham WT,Young JB,et al.Clinical predictors and timing of New York Heart Association class improvement with cardiac resynchronization therapy in patients with advanced chronic heart failure:Results from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE-ICD) trials[J].Am Heart J,2006,151(4):837-843.
[5] Diaz-Infante E,Mont L,Leal J,et al.Predictors of lack of response to resynchronization therapy[J].Am J Cardiol,2005,95(12):1436-1440.
[6] Yin FH,Fan CL,Guo YY,et al.The impact of gender difference on clinical and echocardiographic outcomes in patients with heart failure after cardiac resynchronization therapy:A systematic review and meta-analysis[J].PLoS One,2017,12(4):e0176248.