Han Ya-ling, Zang Hong-yun, Wang Dong-mei, Jing Quan-min, Wang Shou-li, Wang Zu-lu
Department of Cardiology, Shenyang General Hospital of PLA, Shenyang 110016, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2005 Jan;33(1):17-21.
To evaluate the efficacy and safety of percutaneous coronary intervention (PCI) combined cardiac resynchronization therapy (CRT) for refractory heart failure secondary to ischemic cardiomyopathy (ICM).
PCI and CRT were performed in 7 ICM patients confirmed by angiography with NYHA class IV, QRS duration >/= 130 ms in 6 of them, III degrees AVB in 1 patient, fast ventricular heart rate Af in 1 patient, ventricular fibrillation history in 2 patient. All of them had their LVEDD >/= 55 mm, and LVEF </= 0.40 detected by UCG. PCI was performed first in 5 patients, and their follow-up angiography showed no restenosis 6 months after PCI, then CRT was given. CRT was performed first in 2 patients and 2 weeks later PCI was combined.
The procedures of PCI and CRT were performed successfully in all patients. Five patients received right atrial and biventricular pacing, one patient with Af received biventricular pacing and atrial-ventricular node radiofrequency ablation at the same procedure, and the another one patient received CRTD. One out of seven patients died of re-AMI 4 months after the combination therapy, and the other 6 patients had been alive 5 - 41 (23.2 +/- 13.8) months during the follow-up period. The heart function of the 7 patients had further improved after PCI and CRT combined therapy compared to that of PCI or CRT only. Their NYHA class decreased from IV to II, 6-minute walking distance increased steadily, and mitral regurgitation reduced and QRS duration shortened significantly. The LVEDD decreased and LVEF increased significantly in 2 patients without ventricular aneurysm, and slight improvement or no change were in the other 5 patients.
For patients with refractory heart failure secondary to ICM, the combination of PCI and CRT could obviously improve their heart function, quality of life and prognosis, which also very safe in perforation.
评估经皮冠状动脉介入治疗（PCI）联合心脏再同步治疗（CRT）对缺血性心肌病（ICM）所致难治性心力衰竭的疗效及安全性。
对7例经血管造影确诊的ICM患者进行PCI及CRT治疗，其中6例纽约心脏协会（NYHA）心功能分级为IV级，QRS时限≥130 ms，1例为三度房室传导阻滞，1例为快速心室率心房颤动，2例有室颤病史。所有患者经超声心动图（UCG）检测左心室舒张末期内径（LVEDD）≥55 mm，左心室射血分数（LVEF）≤0.40。5例患者先进行PCI，术后6个月复查血管造影显示无再狭窄，随后进行CRT。2例患者先进行CRT，2周后联合PCI。
所有患者的PCI及CRT操作均成功完成。5例患者接受右心房及双心室起搏，1例心房颤动患者在同一操作中接受双心室起搏及房室结射频消融，另1例患者接受CRT-D。7例患者中有1例在联合治疗后4个月死于再发急性心肌梗死（AMI），其余6例患者在随访期间存活5 - 41（23.2±13.8）个月。与单纯PCI或CRT相比，7例患者在PCI联合CRT治疗后心功能进一步改善。NYHA分级从IV级降至II级，6分钟步行距离稳步增加，二尖瓣反流减轻，QRS时限显著缩短。2例无室壁瘤的患者LVEDD减小，LVEF显著增加，其余5例患者有轻微改善或无变化。
对于ICM所致难治性心力衰竭患者，PCI联合CRT可明显改善其心功能、生活质量及预后，且操作安全。
