CRT 对扩张型和缺血性心肌病的左室机械重构疗效观察

Effect of cardiac resynchronization therapy on left ventricular remodeling in ischemic and dilated cardiomyopathy

摘要:

目的 观察心脏再同步化起搏治疗（CRT）对扩张型和缺血性心肌病的左室机械重构疗效差别。 方法 入选21 例慢性充血性心力衰竭患者，分为扩张型心肌病组（13 例）和缺血型心肌病组（8 例）。所有 患者均符合CRT 指南的I 类适应证。分别观察CRT 术后6、12 个月左室射血分数、左房内径、左室收缩内 径、左室舒张内径、左室收缩末期容积、左室舒张末期容积及二尖瓣反流面积的变化。结果 ①扩张型心肌病 组CRT 术后6 个月，左室射血分数较术前增加，左室舒张和收缩末内径，左室舒张和收缩末容积，二尖瓣反流 面积较术前减少（P <0.05），术后12 个月，左室射血分数较术前增加，左室舒张和收缩末内径，左室舒张和收 缩末容积，左房内径较术前减小（P <0.05）；②缺血性心肌病组术后12 个月射血分数较术前增加（P <0.05）； ③扩张型心肌病组CRT 术后6 个月二尖瓣反流面积的变化量大于缺血性心肌病组（P <0.05），射血分数增加 量大于缺血性心肌病（P <0.05），术后12 个月扩张型心肌病组左室收缩末内径、左室舒张和收缩末容积的变化 量大于缺血性心肌病组（P <0.05）。结论 CRT 对扩张型心肌病患者的心室逆重构效果优于缺血性心肌病患者。

Abstract:

Objective To investigate the effect of cardiac resynchronization therapy (CRT) on left ventricular remodeling in patients with ischemic cardiomyopathy or dilated cardiomyopathy. Methods Twenty-one patients with congestive heart failure who were all in accordance with CRT guidelines for class I indication were enrolled. There were 13 patients with dilated cardiomyopathy and 8 patients with ischemic cardiomyopathy. The left ventricular ejection fraction (LVEF), left atrium diameter (LAD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and the area of mitral regurgitation (MRA) were observed 6 and 12 months after CRT. Results In the dilated cardiomyopathy patients, LVEF was increased, and LVESD, LVEDD, LVEDV, LVESV and MRA were reduced 6 months after CRT (P < 0.05); LVEF was increased while LVESD, LVEDD, LVEDV, LVESV and LAD were reduced 12 months after CRT (P < 0.05). In the ischemic cardiomyopathy group, LVEF was increased 12 months after CRT (P < 0.05). MRA and LVEF in the dilated cardiomyopathy group were changed more remarkably than those of the ischemic cardiomyopathy group 6 months after CRT (P < 0.05); LVESD, LVEDV and LVESV in the dilated cardiomyopathy group were changed more remarkably than those of the ischemic cardiomyopathy group 12 months after CRT (P < 0.05). Conclusions The effect of CRT on left ventricular remodeling in patients with dilated cardiomyopathy is much better than that in patients with ischemic cardiomyopathy.