心脏再同步治疗对左心耳功能及肺静脉血流模式的影响。

Effect of cardiac resynchronization therapy on left atrial appendage function and pulmonary venous flow pattern.

作者信息

Vural Ahmet, Agacdiken Aysen, Ural Dilek, Sahin Tayfun, Kozdag Guliz, Kahraman Göksel, Ural Ertan, Akbas Haluk, Suzer Kaya, Komsuoglu Baki

机构信息

Department of Cardiology, Kocaeli University Medical Faculty, 41900 Derince, Kocaeli, Turkey.

出版信息

Int J Cardiol. 2005 Jun 22;102(1):103-9. doi: 10.1016/j.ijcard.2004.05.011.

DOI:10.1016/j.ijcard.2004.05.011

PMID:15939105

Abstract

BACKGROUND

Previous studies have shown improvement in left ventricular function and development of the reverse remodeling in the left ventricle and left atrium after cardiac resynchronization therapy (CRT). The aim of this study was to investigate the effect of CRT on left atrial appendage (LAA) function and pulmonary venous flow pattern.

METHODS

Eighteen patients with systolic heart failure and complete left bundle branch block underwent implantation of biventricular pacemaker devices. In order to follow changes in LAA, transthoracic and transesophageal echocardiographic examinations were performed 1 week before and repeated 1 and 6 months after pacemaker implantation.

RESULTS

CRT resulted in significant clinical improvement and decrease in NYHA functional class in 17 patients (94%). Maximum and minimum areas of left atrial appendage (LAAAmax and LAAAmin) decreased, with a concomitant increase in LAA ejection fraction. [LAAAmax: from 4.6+/-2 to 4.2+/-1.8 cm2 at the first (P < 0.001) and to 4.0+/-1.8 cm2 at the sixth month (P < 0.001); LAAAmin: from 2.7+/-1.3 to 2.3+/-1.2 cm2 at the first (P < 0.001) and to 2.2+/-1.2 cm2 at the sixth month (P < 0.001) and LAA ejection fraction: from 41+/-12% to 46+/-10% at the first (P = 0.007) and to 47+/-8% at the sixth month (P = 0.003)]. LAA active emptying and filling flow and pulmonary venous systolic velocities also increased after CRT. The appendage active emptying velocity correlated significantly with left ventricular ejection fraction (r = 0.50, P = 0.002), LAA ejection fraction (r = 0.51, P = 0.002), left atrial maximal volume, LAVmax (r = -0.44, P = 0.007), left atrial minimal volume, LAVmin (r = -0.50, P = 0.002) and pulmonary vein systolic flow velocity (r = 0.33, P = 0.05).

CONCLUSION

Treatment of heart failure by CRT results with marked improvements in LAA function and increases pulmonary venous systolic velocity.

摘要

背景

先前的研究表明，心脏再同步治疗（CRT）后左心室功能有所改善，左心室和左心房出现逆向重构。本研究的目的是探讨CRT对左心耳（LAA）功能和肺静脉血流模式的影响。

方法

18例收缩性心力衰竭合并完全性左束支传导阻滞患者接受双心室起搏器植入。为了跟踪LAA的变化，在起搏器植入前1周进行经胸和经食管超声心动图检查，并在植入后1个月和6个月重复检查。

结果

CRT使17例患者（94%）临床症状显著改善，纽约心脏协会（NYHA）心功能分级降低。左心耳最大和最小面积（LAAAmax和LAAAmin）减小，同时LAA射血分数增加。[LAAAmax：第1个月时从4.6±2降至4.2±1.8 cm²（P<0.001），第6个月时降至4.0±1.8 cm²（P<0.001）；LAAAmin：第1个月时从2.7±1.3降至2.3±1.2 cm²（P<0.001），第6个月时降至2.2±1.2 cm²（P<0.001）；LAA射血分数：第1个月时从41±12%升至46±10%（P=0.007），第6个月时升至47±8%（P=0.003）]。CRT后LAA主动排空和充盈血流以及肺静脉收缩期速度也增加。附属器主动排空速度与左心室射血分数（r=0.50，P=0.002）、LAA射血分数（r=0.51，P=0.002）、左心房最大容积LAVmax（r=-0.44，P=0.007）、左心房最小容积LAVmin（r=-0.50，P=0.002）和肺静脉收缩期血流速度（r=0.33，P=0.05）显著相关。