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心脏再同步诱导主要的结构和功能逆转重塑在纽约心脏协会等级I/II心力衰竭的患者
Martin St John Sutton1, Stefano Ghio, Ted Plappert
1University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. suttonm@mail.med.upenn.edu
Circulation
|October 28, 2009
概括
心脏再同步治疗 (CRT) 在早期心力衰竭患者中显著逆转左心室重塑. 非缺血性心力衰竭患者经历了CRT的最大改善.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭研究研究
- 医疗器械技术 医疗器械技术
背景情况:
- 心脏再同步疗法 (CRT) 已被确立为高级心力衰竭 (NYHA III/IV类) 延长的QRS.
- 在心力衰竭早期阶段 (NYHA I/II类) 中,CRT对左心室 (LV) 反向重塑的影响尚不清楚.
- 目前尚不清楚心力衰竭的病因是否会影响CRT的逆转重塑效应.
研究的目的:
- 调查CRT是否诱导纽约心脏协会 (NYHA) 类I/II缩性心力衰竭患者的左心室 (LV) 反向重塑.
- 为了确定心力衰竭的原因是否改变了CRT实现的逆重塑的程度.
主要方法:
- 一项随机对照试验,涉及610名患有NYHA类I/II心力衰竭的患者,QRS持续时间≥120毫秒,LV末端透气尺寸≥55毫米,LV喷射率≤40%.
- 患者被分配到12个月的CRT上 (n=419) 或CRT关闭 (n=191).
- 用多普勒回声心脏图来评估基线和6个月和12个月的LV结构和功能.
主要成果:
- 与CRT关闭相比,CRT在12个月内显著降低了LV终端透气和终端静脉体积指数 (P<0.001) 和增加了LV射出分数 (P<0.0001),与CRT关闭相比.
- 在CRT激活后,LV体积和射出分数的初始急性变化与长期重塑无关.
- 与非缺血性心力衰竭患者相比,非缺血性心力衰竭患者的LV体积减少了3倍,射出分数增加了3倍.
结论:
- 在一年内,CRT在NYHAI/II类心力衰竭患者中导致显著的结构和功能逆向重塑.
- 在非缺血性心肌病患者中,CRT的最大益处被观察到.
- 在这种患者群体中,CRT可能是中断心力衰竭自然进展的策略.
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