重同步治疗刺激部位对心力衰竭患者的缩功能的影响
C Butter1, A Auricchio, C Stellbrink
1German Heart Institute and Charité, Campus Virchow Klinikum, Berlin, Germany.
Circulation
|December 19, 2001
概括
使用左心室 (LV) 自由壁刺激的心脏再同步治疗 (CRT) 与前壁刺激相比,显著改善了心脏功能. 这一发现突显了最佳的LV置位置对于改善心力衰竭患者结果的重要性.
科学领域:
- 心脏病学 心脏病学
- 生物医学工程 生物医学工程
- 心脏衰竭管理的管理
背景情况:
- 心脏再同步疗法 (CRT) 增强心力衰竭患者的心脏功能,导致导电延迟.
- 最佳的左心室 (LV) 位对CRT疗法的有效性至关重要,但特定于该部位的血液动力学效应尚未得到充分证实.
研究的目的:
- 用两个不同的LV刺激部位来比较CRT的血液动力学反应:自由壁与前壁.
- 为了确定LV刺激部位在CRT期间对缩性表现的影响.
主要方法:
- 研究了来自PATH-CHF-II试验的30名心力衰竭患者 (NYHA类2.7,QRS152毫秒).
- 在各种AV延迟时,使用LV和双心脏 (BV) 刺激进行CRT,LV导线放置在自由壁或前壁上.
- 血液动力学参数,包括LV dP/dt ((max)) 和大动脉脉压,被测量并比较刺激部位.
主要成果:
- 与前壁刺激相比,LV自由壁刺激导致LVdP/dt(max) (14%,对LV6%,对BV12%,对BV5%) 和脉冲压 (8%,对LV4%,对BV9%,对BV5%) 的显著增加.
- 一小部分患者 (三分之一) 经历了前壁刺激下降的LV缩功能,而自由壁刺激始终改善了它.
结论:
- 在CRT期间,左心室自由壁刺激显著提高了与前壁刺激相比,LV缩性表现.
- 这些发现表明,LV自由壁是CRT放置的优越位置,需要进一步研究长期临床益处.
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