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|本期目录/Table of Contents|

动态优化AV/VV间期心脏再同步治疗慢性心力衰竭的临床观察

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第1期
页码:
100-102,106
栏目:
临床研究
出版日期:
2010-10-27

文章信息/Info

Title:
Short- and mid-term clinical effectiveness of cardiac resynchronization therapy optimized AV/VV delay dynamically for patients with congestive heart failure
作者:
杨立波; 贾绍斌; 张华; 刘志军
宁夏医科大学附属医院心脏中心，宁夏 银川 750004
Author(s):
YANG Li-bo;  JIA Shao-bin;  ZHANG Hua;  LIU Zhi-jun
Center of Cardiology, Affiliate Hospital, Ningxia Medical University, Yinchuan 750004, Ningxia, China
关键词:
心脏再同步化治疗; AV/VV间期优化; 组织多普勒; 脑钠尿肽
Keywords:
cardiac resynchronization therapy;  optimized AV/VV;  tissue Doppler imaging;  brain natrinuretic peptide
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的: 观察动态优化AV/VV间期心脏再同步治疗（cardiac resynchronization therapy，CRT）治疗慢性心力衰竭（CHF）的短中期疗效。方法： 12例CHF晚期患者接受CRT治疗，分别于植入前、植入术后3、6个月在超声心动图指导下优化房室（AV）间期和室室（VV）间期，同时观察心腔结构、二尖瓣返流及心电图、脑钠尿肽（BNP）检查等，评价CRT临床疗效。结果： 最佳优化AV间期120～180（158±19）ms和VV间期4～28（16±7）ms，临床症状改善，六分钟步行距离由(257±23)m增加至(344±21)m，QRS时限由（136±17）ms降至(109±12)ms(P<0.01,P<0.05)。植入后左室舒张末内径（LVEDD）较植入前明显缩小［(71±10) mm vs. (54±4),P<0.05］; 左室射血分数（LVEF）提高［(0.308±0.022) vs. (0.531±0.085),P<0.01］；血浆BNP值由植入前（876±415）ng/L降至(70±28)ng/L(P<0.05)。结论： 动态程控AV/VV间期可以提高CRT对CHF患者短、中期疗效。
Abstract:
AIM: To observe the short-term and mid-term clinical effectiveness of cardiac resynchronization therapy (CRT) optimized AV/VV delay dynamically for patients with congestive heart failure (CHF). METHODS: Twelve patients with refractory heart failure received CRT device implantation. Pacing parameters were tested and AV/VV interval was optimized by the guidance of echocardiography during the follow-up period. The effectiveness of CRT was evaluated in terms of echocardiography, tissue Doppler, ECG and BNP during the follow-up period. RESULTS: The best optimized AV delay was between 120 msec and 180 msec (158±19)msec and the best optimized VV delay was between 4 msec and 28 msec (16±7)msec. The heart function classification, quality of life, 6-min hall walking distance was significantly increased (257±23)m to (344±21)m. QRS interval decreased from (136±17)msec to (109±12)msec (P<0.05). With significant reduction of left ventricular end-diastolic (LVEDD) ［(71±10)mm vs.(54±4), P<0.05］, the left ventricular ejection fraction (LVEF) increased ［(0.308±0.022) vs.(0.531±0.085), P<0.01］. Plasma BNP decreased from (876±415)ng/L to (70±28)ng/L (P<0.05) and the intra- and inter-ventricular asynchrony indexes were significantly improved. CONCLUSION: Dynamically optimized AV/VV delay of the pacemaker parameters enhances the short- and mid-term effects of CRT.

参考文献/References

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[2]Cazeau S, Leclercq C, Lavergne T, et al. For the Multisite Stimulation in Cardiomyopathies (MUSTIC) study investigator. Effect of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay[J]. N Engl J Med, 2001, 344(12):873-880.

[3]Abraham WT, Fisher WG, Smith AL, et al. MIRACLE Study Group. Multicenter InSync randomized clinical evaluation. Cardiac resynchronization in chronic heart failure[J]. N Engl J Med, 2002, 346(24):1845-1853.

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[7]Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on mortality in heart failure[J]. N Engl J Med, 2005, 352(15):1539-1549.

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[9]Baker JH 2nd, McKenzie J 3rd, Beau S, et al. Acute evaluation of programmer guided AV/PV and VV delay optimization comparing an IEGM method and echocardiogram for cardiac resynchronization therapy in heart failure patients and dual-chamber ICD implants[J]. J Cardiovasc Electrophysiol, 2007, 18(2):185-191.

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备注/Memo

备注/Memo:
收稿日期：2010-01-05.通讯作者：贾绍斌，主任医师，主要从事心脏冠心病介入及电生理研究 Email:shaobinjia@hotmail.com 作者简介：杨立波，硕士生Email:675107325@qq.com
更新日期/Last Update: 2010-10-27