短暂中断慢性心力衰竭患者心脏再同步化治疗后心脏运动同步性变化的临床研究

目的：观察短暂中断心脏再同步化治疗（CRT）后慢性心力衰竭患者（CHF）心脏运动同步性的变化,探讨CRT逆重构组与非逆重构组同步性的获益情况。方法：连续选择CRT术后6月以上的患者46例,根据左室收缩末容积减小≥15%分为逆重构组和非逆重构组。分别于起搏器关闭前及关闭后10分钟超声心动图检查房室间延迟（AVD）、心室间延迟（IVD）、2节段径向应变达峰时间标准差（PTrs-12SD）、12节段环向应变达峰时间标准差（PTcs-12SD）及16节段纵向应变达峰时间标准差（PTls-16SD）,比较起搏器关闭前后上述参数的变化。结果：两组患者中断CRT 10分钟后AVD均减小（非逆重构组P〈0.05,逆重构组P〈0.01）,逆重构组IVD减小（P〈0.01）,非逆重构组IVD于CRT关闭后变化无统计学意义（P〉0.05）;两组患者左室内同步化参数PTcs-12SD、PTrs-12SD、PTls-16SD在中断CRT 10分钟后的变化均无统计学意义（P〉0.05）。结论：中断CRT10分钟后,两组患者房室失同步均加重,仅逆重构组心室间失同步显著恶化。提示CRT期间,两组患者均可持续获得房室同步性益处,逆重构患者可获得心室间同步性益处;中断CRT10分钟后,两组左心室内同步性均未发生显著性改变,这种无差异的现象,需要进一步研究。

Left Ventricular Synchronization Changes after Cardiac Resynchronization Therapy was Temporarily Interrupted

Objective： To observe the synchronization changes of acute after CRT interruption in patients with chronic heart failure（CHF）, and explore the benefit of synchronization of the reverse remodeling and non-reverse remodeling CHF patients during CRT. Method： 46 CHF patients who had undergone implantation of CRT device for more than 6 months were enrolled in the study. The reverse remodeling and non-reverse remodeling were identified by reduction of LV end-systolic volumes ≥ 15%. The two groups underwent echocardiography, and AVD, IVD, PTrs-12SD, PTcs-12SD and PTls-16SD were measured in ＂on＂ and ＂off＂ mode of CRT.The changes of above mentioned parameters were compared in the two groups in CRT on and off modes. Result： CRT interruption caused worsening of AVD in two groups（Non- revese remodeling group P0.05, revese remodeling group P0.01）. Revese remodeling group had significant worsening of IVD（P0.01）, but Non- revese remodeling group had no significant change after 10 minutes interruption of CRT（P0.05）. There were no significant changes in PTcs-12SD, PTrs-12SD and PTls-16SD after 10 minutes interruption of CRT as compared to CRT-on mode in both groups（P0.05）. Conclusion： After 10 minutes interruption of CRT, atrio-ventricular asynchrony were deteriorated in both groups, however, inter-ventricular synchrony was deteriorated only in reverse remodeling group.It suggested that patients of both groups have obtained atrio-ventricular asynchrony benefits continuously during CRT. Reverse remodeling group have obtained inter-ventricular synchrony benefits. The phenomenon on no significant deterioration of intra-ventricular asynchrony in both groups after 10 minutes interruption of CRT may be affected by many factors, and further research is required.