论文部分内容阅读
目的 分析心脏再同步化治疗(CRT)在射血分数降低的心力衰竭患者中超反应的预测因素,并观察超反应对患者心功能及预后的影响.方法 回顾性分析连续的因心力衰竭于本院植入CRT的患者,以术后6个月随访的左室射血分数(LVEF)测定值≥0.50为标准分为超反应组和非超反应组,通过组间比较以及多因素Logstic回归分析筛选出CRT超反应的独立预测因子.根据术前及术后第1,3和6个月的心脏超声指标LVEF、左室舒张末径(LVEDD)和左室收缩末径(LVESD)以及随访记录到的不良事件,观察超反应对患者心脏结构、心功能以及预后的影响.结果 共有43例入选,其中13例(30.2％)出现超反应.与非超反应组相比,超反应组的非缺血性心肌病比例较高(100％ vs 63.3％,P=0.032),心力衰竭病程较短[中位病程12(6～90)个月vs 66(24～108)个月,P=0.04],术前基线LVEF较高(0.32±0.04 vs 0.27±0.06,P=0.008).而非缺血性病因(OR=13.580,95％CI 1.154～160.055,P=0.038)和术前基线LVEF在0.30～0.35之间(OR=12.138,95％CI 1.492～80.597,P=0.01)是术后发生超反应的独立预测因子.超反应组术后LVEF、LVEDD和LVESD的改善整体优于非超反应组(P＜0.001).超反应组复合终点事件(心力衰竭再住院、恶性心律失常、全因死亡)的发生率低于非超反应组(15.4％ vs 56.7％,P=0.012),术后两年的无事件生存率高于非超反应组(log rank P =0.028).结论 非缺血性心肌病以及术前LVEF相对较高的患者更容易从CRT治疗中获益,且获益主要来源于心脏结构与功能的改善以及不良事件发生率的降低.“,”Objective To analyze predictors of super-response to cardiac resynchronization therapy (CRT) in heart failure patients with reduced ejection fraction and observe the impacts of super-response on cardiac function and prognosis.Methods We retrospectively analyzed consecutive patients who received CRT implantation in our cen ter.Patients were categorized into the super-response and the nonsuper-response group according to the criteria as defined by left ventricular ejection fraction(LVEF)≥0.50 six months after the operation.We used comparison between groups and multivariate Logistic regression analysis to find the independent predictors of super-response to CRT.The impacts of super-response on cardiac structure,function and prognosis were observed through follow-up echocardiography data including LVEF,left ventricular end-diastolic dimension (LVEDD) and left ventricular endsystolic dimension(LVESD) and recorded adverse events.Results Forty-three patients were enrolled,thirteen(30.2 ％)of whom developed super-response.As compared with the control group,there was an increased percentage of nonischemic cardiomyopathy in the super-response group (100％ vs 63.3％,P =0.032).The super-response group also had a shorter course [median course 12 (6-90) months vs 66 (24-108) months,P =0.04] and higher baseline level of LVEF (0.32±0.04 vs 0.27±0.06,P =0.008).Nonischemic etiology (OR =13.580,95 ％CI 1.154-160.055,P=0.038) and baseline level of LVEF ranging from 0.30-0.35 (OR=12.138,95％CI 1.492-80.597,P=0.01) were the independent predictors of super-response after CRT implantation.The improvement in LVEF,LVEDD and LVESD of the super-response group performed significantly better than the nonsuper-response group (P ＜0.001).The rate of composite endpoint events (readmission for heart failure,malignant arrhythmia or all-cause mortality) was lower in the super-response group compared with the control group (15.4 ％ vs 56.7 ％,P =0.012).In the first two years after implantation,the event-free survival rate was significantly higher in super-response patients (log-rank P=0.028).Conclusion Patients with nonischemic cardiomyopathy and relatively higher baseline level of LVEF àre more likely to benefit from CRT implantation and these benefits primarily result from the improvement of cardiac structure and function as well as the decrease in adverse events.