论文部分内容阅读
目的:分析合并左心室收缩功能不全的三度房室传导阻滞(AVB)患者应用心脏再同步化治疗(CRT)后发生左心室重构逆转的预测因素。方法:选取2009-01至2015-05在安徽省立医院植入CRT的三度AVB患者65例,收集术前临床资料及术后随访资料,术后12个月左心室收缩末期容积(LVESV)较术前下降≥15%或左心室射血分数(LVEF)增加≥5%定义为左心室重构逆转。将患者分为逆转组(n=36)和无逆转组(n=29),比较两组患者的临床资料,并采用二分类Logisitic回归模型分析CRT逆转左心室重构的预测因素。结果:共入选患者65例,平均年龄(62±14)岁,随访12个月,发生心室重构逆转的患者为36例(55.4%),逆转组女性(P=0.011)、基线QRS时限>120 ms(P=0.001)、心室间激动延迟(IVMD)≥40 ms(P=0.027)、心率校正后的心电图Q波起始点距离左心室16节段最小容积点时间间隔的标准差[Tmsv16-SD(%R-R)]≥8.3%(P=0.001)的比例高于无逆转组,二元Logisitic回归分析显示,女性(OR=6.228,95%CI:1.561~24.842,P=0.01)、QRS时限>120 ms(OR=7.778,95%CI 1.996~30.769,P=0.003)与Tmsv16-SD(%R-R)≥8.3%(OR=8.134,95%CI:2.064~32.057,P=0.003)是心室重构发生逆转的独立预测因素。结论:对于合并左心室收缩功能不全的三度AVB患者,女性、QRS时限>120 ms及Tmsv16-SD(%R-R)≥8.3%或可作为CRT逆转左心室重构的预测因素。
AIM: To analyze the predictors of left ventricular remodeling reversal after cardiac resynchronization therapy (CRT) in patients with third degree atrioventricular block (AVB) with left ventricular systolic dysfunction. Methods: Sixty-five patients with third-degree AVB who underwent CRT implantation at Anhui Provincial Hospital from January 2009 to May 2015 were selected. Preoperative clinical data and postoperative follow-up data were collected. Left ventricular end-systolic volume (LVESV) More than 15% reduction in preoperative or left ventricular ejection fraction (LVEF) ≥ 5% increase is defined as left ventricular remodeling reversal. The patients were divided into the reversal group (n = 36) and the non-reversal group (n = 29). The clinical data of the two groups were compared and the predictive factors of CRT in reversing left ventricular remodeling were analyzed by two-component Logisitic regression model. Results: A total of 65 patients (mean age 62 ± 14 years) were followed up for 12 months. Thirty-six patients (55.4%) had reversal of ventricular remodeling, and women in reversal group (P = 0.011) (P = 0.001), IVMD ≥40 ms (P = 0.027), and the standard deviation of the Q-wave electrocardiogram starting point from the left ventricular 16-segment minimum volume point time interval [Tmsv16- (OR = 6.228, 95% CI: 1.561-24.842, P = 0.01), QRS time limit (OR = 6.228, 95% CI: 1.561-24.842, P = 0.001) (OR = 8.134, 95% CI: 2.064-32.057, P = 0.003) was> 120 ms (OR = 7.778,95% CI 1.996-30.769, P = 0.003) and Tmsv16-SD Independent predictors of structural reversal. CONCLUSIONS: Women with QRS duration> 120 ms and Tmsv16-SD (% R-R) ≥ 8.3% may be useful predictors of left ventricular remodeling in CRT patients with third-degree AVB complicated with left ventricular systolic dysfunction.