Molhoek Sander G, Bax Jeroen J, van Erven Lieselot, Bootsma Marianne, Boersma Eric, Steendijk Paul, van der Wall Ernst E, Schalij Martin J
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Cardiol. 2004 Apr 1;93(7):860-3. doi: 10.1016/j.amjcard.2003.12.024.
Cardiac resynchronization therapy (CRT) is a recently introduced therapeutic option for patients with severe heart failure and intraventricular conduction disturbances. However, it is estimated that 20% to 30% of patients may not respond to CRT. Patients with ischemic cardiomyopathy (IC) may respond less favorably to CRT compared with patients with idiopathic dilated cardiomyopathy (IDC). Accordingly, the beneficial effects of CRT were evaluated in 2 subsets of patients (IC and IDC). Seventy-four patients with end-stage heart failure, New York Heart Association (NYHA) class III or IV, left ventricular (LV) ejection fraction <35%, QRS >120ms, and left bundle branch block received a biventricular pacemaker. At baseline and 6 months after implantation these parameters were evaluated: NYHA class, Minnesota quality-of-life score, QRS duration, and 6-minute walking distance. LV ejection fraction and severity of mitral regurgitation were assessed before and 6 months after CRT using 2-dimensional echocardiography. Long-term follow-up and hospitalization rates were obtained up to 2 years. Of the 74 patients, 46% (n = 34) had IC and 54% (n = 40) IDC. At 6 months follow-up all clinical parameters, QRS duration, LV ejection fraction, and mitral regurgitation improved significantly in both groups. Long-term (2-year) follow-up showed a survival rate of 87.5% for patients with IDC and 88.3% for patients with IC. The percentages of responders to CRT (defined as an improvement in NYHA class >or=1 grade) were comparable in both groups (65% vs 71%). Therefore, the underlying etiology of heart failure (IC vs IDC) was not related to the response to CRT.
心脏再同步治疗（CRT）是最近针对重度心力衰竭和室内传导障碍患者推出的一种治疗选择。然而，据估计有20%至30%的患者可能对CRT无反应。与特发性扩张型心肌病（IDC）患者相比，缺血性心肌病（IC）患者对CRT的反应可能较差。因此，在两组患者（IC和IDC）中评估了CRT的有益效果。74例纽约心脏协会（NYHA）心功能III级或IV级、左心室（LV）射血分数<35%、QRS>120ms且存在左束支传导阻滞的终末期心力衰竭患者接受了双心室起搏器治疗。在基线和植入后6个月评估以下参数：NYHA分级、明尼苏达生活质量评分、QRS时限和6分钟步行距离。使用二维超声心动图在CRT治疗前和治疗后6个月评估LV射血分数和二尖瓣反流的严重程度。获得了长达2年的长期随访和住院率。在这74例患者中，46%（n = 34）患有IC，54%（n = 40）患有IDC。在6个月的随访中，两组的所有临床参数、QRS时限、LV射血分数和二尖瓣反流均有显著改善。长期（2年）随访显示，IDC患者的生存率为87.5%，IC患者为88.3%。两组中对CRT有反应者（定义为NYHA分级改善≥1级）的百分比相当（65%对71%）。因此，心力衰竭的潜在病因（IC与IDC）与对CRT的反应无关。
