Sunsaneewitayakul Buncha, Sitthisook Surapun, Sangwatanaroj Somkiat, Prechawat Somchai, Songmuang Smonporn Boonyaratavej
Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Rd, Patumwan, Bangkok 10330, Thailand.
J Med Assoc Thai. 2007 Jul;90(7):1458-66.
Heart failure is a major and growing public health problem in developed and developing countries. Despite major advances in medical therapy, morbidity and mortality remain high. Cardiac resynchronization therapy (CRT) has been proposed as an adjunctive therapy in patients with drug-refractory heart failure and ventricular conduction delay. Short and long-term studies have demonstrated the clinical benefits of CRT.
The present study was designed to assess the feasibility, safety, and mid-term efficacy of CRT in patients with severe heart failure and ventricular conduction delay in the institute.
Ten patients with severe heart failure in New York Heart Association (NYHA) functional class III or IV with left ventricular ejection fraction (LVEF) < 35%, QRS duration >120 ms with left bundle branch block morphology received CRT At baseline, and 6 months after implantation, the following parameters were evaluated: NYHA class, QRS duration, LVEF N-terminal pro-brain natriuretic peptide (NT-pro BNP) level, 6-minute walking distance, SF-36 quality-of-life (QOL) score, and number of heart failure visit.
All clinical parameters improved significantly at 6 months. NYHA class decreased from 3.5 +/- 0.5 to 2.4 +/- 0.7 (p < 0.01). QRS duration decreased from 145 +/- 22 ms to 126 + 6 ms (p < 0.01). LVEF increasedfrom 21 +/- 6% to 31 +/- 12% (p < 0.01). NT-pro BNP level decreased from 2503 +/- 1953 pg/ml to 767 +/- 342 pg/ml (p < 0.01). The 6-minute walking distance increased from 153 +/- 122 m to 278 +/- 128 m (p < 0.01). QOL score improved from 66 +/- 14 to 98 +/- 25 (p < 0. 01). The number of heart failure visits was reduced from 3.8 +/- 3.7 per year to 0.5 +/- 0.8 visit per year (p < 0.01). Seventy percent of patients were free of heart failure visit for one year after implantation. One patient had sudden cardiac death eleven months after implantation. There was no procedure-related mortality. One patient had left ventricular lead dislodgement 3 months after implantation.
In the present study, CRT was safe and effective in improving heart failure symptom, functional status, LV function, and quality of life. CRT also reduced heart failure hospitalization in the presented severe heart failure and ventricular conduction delay patients.
心力衰竭在发达国家和发展中国家都是一个重大且日益严重的公共卫生问题。尽管药物治疗取得了重大进展，但发病率和死亡率仍然很高。心脏再同步治疗（CRT）已被提议作为药物难治性心力衰竭和心室传导延迟患者的辅助治疗方法。短期和长期研究均已证明CRT的临床益处。
本研究旨在评估CRT在本机构中重度心力衰竭和心室传导延迟患者中的可行性、安全性及中期疗效。
10例纽约心脏协会（NYHA）心功能分级为III或IV级、左心室射血分数（LVEF）<35%、QRS时限>120 ms且呈左束支传导阻滞形态的重度心力衰竭患者接受了CRT治疗。在基线时以及植入后6个月，评估以下参数：NYHA分级、QRS时限、LVEF、N末端脑钠肽前体（NT-pro BNP）水平、6分钟步行距离、SF-36生活质量（QOL）评分以及心力衰竭就诊次数。
6个月时所有临床参数均有显著改善。NYHA分级从3.5±0.5降至2.4±0.7（p<0.01）。QRS时限从145±22 ms降至126±6 ms（p<0.01）。LVEF从21±6%升至31±12%（p<0.01）。NT-pro BNP水平从2503±1953 pg/ml降至767±342 pg/ml（p<0.01）。6分钟步行距离从153±122 m增至278±128 m（p<0.01）。QOL评分从从66±14提高到98±25（p<0.01）。心力衰竭就诊次数从每年3.8±3.7次降至每年0.5±0.8次（p<0.01）。70%的患者在植入后一年内未发生心力衰竭就诊。1例患者在植入后11个月发生心源性猝死。无手术相关死亡病例。1例患者在植入后3个月发生左心室导线脱位。
在本研究中，CRT在改善心力衰竭症状、功能状态、左心室功能和生活质量方面是安全有效的。CRT还减少了本研究中重度心力衰竭和心室传导延迟患者的心力衰竭住院率。
