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目的:观察慢性心衰患者经心脏再同步化治疗(cardiac resynchronization therapy,CRT)的临床疗效,并分析CRT无应答的影响因素。方法:入选2010年1月至2015年7月上海长海医院心血管内科因心衰接受CRT的患者共47例,收集病史资料、手术资料、术后资料以及随访,比较CRT有无应答患者的临床特征,并通过多因素回归分析CRT无应答的危险因素。结果:纳入病例数共47例,其中CRT应答34例(72.3%),CRT无应答13例(27.7%)。CRT无应答组中心房颤动和冠脉问题发生率明显高于CRT应答组(P<0.05);CRT应答组中左心房容积、右心房容积、左心室容积以及二尖瓣返流量均明显低于CRT无应答组(P<0.05)。多因素回归分析显示患者合并心房颤动或冠脉问题是CRT无应答可以影响CRT的应答。结论:CRT对慢性心衰患者具有较好的疗效,而合并心房颤动或冠脉问题是预测慢性心衰患者CRT无应答的独立影响因素。
Objective: To observe the clinical efficacy of cardiac resynchronization therapy (CRT) in patients with chronic heart failure and to analyze the influencing factors of nonresponse to CRT. Methods: From January 2010 to July 2015, 47 patients with CRT undergoing heart failure due to heart failure were enrolled in Shanghai Changhai Hospital. The clinical data, surgical data, postoperative data and follow-up were collected. The clinical data of patients with or without CRT were compared The risk factors for CRT nonresponse were analyzed by multivariate regression. Results: A total of 47 cases were enrolled in the study, including 34 cases of CRT (72.3%) and 13 cases (27.7%) of CRT without response. The incidence of atrial fibrillation and coronary artery disease in CRT non-responders was significantly higher than that in CRT responders (P <0.05). Left atrial volume, right atrium volume, left ventricular volume, and mitral regurgitation were significantly lower in CRT responders CRT non-response group (P <0.05). Multivariate regression analysis showed that patients with atrial fibrillation or coronary artery disease is a non-response to CRT CRT can affect the response. Conclusion: CRT has a good effect in patients with chronic heart failure, and the combination of atrial fibrillation or coronary artery disease is independent predictors of CRT non-response in patients with chronic heart failure.