心脏再同步治疗：左心室逆向重构中的性别差异
Cardiac resynchronization therapy: gender related differences in left ventricular reverse remodeling.
作者信息
Lilli Alessio, Ricciardi Giuseppe, Porciani Maria Cristina, Perini Alessandro Paoletti, Pieragnoli Paolo, Musilli Nicola, Colella Andrea, Del Pace Stefano, Michelucci Antonio, Turreni Federico, Sassara Massimo, Achilli Augusto, Barold S Serge, Padeletti Luigi
机构信息
Department Heart and Vessels, University of Florence, Viale Morgagni 85, Florence, Italy.
出版信息
Pacing Clin Electrophysiol. 2007 Nov;30(11):1349-55. doi: 10.1111/j.1540-8159.2007.00870.x.
AIM
Gender related differences in epidemiology, treatment, and prognosis of heart failure (HF) have been reported. We examined the sex influence in patients treated with cardiac resynchronization therapy (CRT).
METHODS AND RESULTS
Out of 334 consecutive HF patients (19.7% women) who underwent CRT, 195 patients reached clinical and echocardiographic evaluation at six and 12 months and were selected for analysis. A reduction in left ventricular (LV) end-diastolic volume/m(2) (EDVi) and end systolic volume/m(2) (ESVi) was evident in the overall population at six months (P < 0.001) and from six to 12 months (P < 0.001). Compared to men, women showed significantly greater changes in LV volumes at mid (P < 0.05) and long-term (P < 0.001) follow-up and a significantly higher LV ejection fraction (EF) (40.8 +/- 12.3 vs 34.1 +/- 10.1, P < 0.01) at one year. Multiple regression analysis, including several demographic and clinical parameters, revealed that female gender is independently associated with greater reduction in LV ESVi. At the 12-month follow-up, the proportion of responders (defined in terms of ESV reduction by at least 10%) was higher in women than in men (76.1% vs 59.3%, P < 0.05).
CONCLUSIONS
CRT induced a gender specific LV remodeling response.
目的
已有报道称心力衰竭（HF）在流行病学、治疗及预后方面存在性别差异。我们研究了心脏再同步治疗（CRT）患者中的性别影响因素。
方法与结果
在334例接受CRT的连续性HF患者（女性占19.7%）中，195例患者在6个月和12个月时进行了临床及超声心动图评估，并被选入分析。总体人群在6个月时（P<0.001）以及6至12个月时（P<0.001），左心室（LV）舒张末期容积/平方米（EDVi）和收缩末期容积/平方米（ESVi）均明显降低。与男性相比，女性在中期（P<0.05）和长期（P<0.001）随访时LV容积变化显著更大，且在1年时LV射血分数（EF）显著更高（40.8±12.3对34.1±10.1，P<0.01）。多项回归分析纳入了多个人口统计学和临床参数，结果显示女性性别与LV ESVi的更大降低独立相关。在12个月随访时，女性反应者（定义为ESV降低至少10%）的比例高于男性（76.1%对59.3%，P<0.05）。
结论
CRT诱导了性别特异性的LV重构反应。
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