Ozabalova Eva, Novak Miroslav, Krejci Jan, Hude Petr, Lipoldova Jolana, Meluzin Jaroslav, Vank Pavel, Vitovec Jiri
1st Department of Internal Medicine, St. Anne's University Hospital in Brno.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Mar;154(1):31-7. doi: 10.5507/bp.2010.008.
To evaluate the therapeutic effect of resynchronization in patients with chronic heart failure who are symptomatic despite adequate pharmacological medication.
118 patients with chronic heart failure, mostly dilated cardiomyopathy and ischaemic heart disease, with depressed systolic function, decreased left ventricular ejection fraction (LVEF) and left bundle branch block wide QRS complex, underwent implantation of the biventricular system between the years 2000-2006. We assessed changes in the NYHA functional class, hemodynamic parameters acquired during right heart catheterization, the maximum oxygen consumption during stress spiroergometric examination, as well as echocardiographic parameters.
A statistically significant improvement was found in the NYHA functional class (from 2.8 +/- 0.4 to 2.3 +/- 0.5 after 3 m, p < 0,001 and to 2.5 +/- 0.6 after 12 m, p < 0,01 respectively), as well as an increase in the maximum oxygen consumption during spiroergometric examination (VO2 max from 14.1 +/- 3.1 ml/kg/min to 15.3 +/- 3.1 ml/kg/ min, p < 0,001 and to 15.3 +/- 2.5 ml/kg/min, p = NS respectively). In regard to hemodynamic parameters, there were increases in cardiac output and cardiac index after three months. After 12 months the change was not statistically significant (CO from 3.9 +/- 1 l/min to 4.2 +/- 0.9 l/min, p < 0,05, and to 4.1 +/- 0.9 l/min, p = NS, CI from 2 +/- 0.5 l/kg/min to 2.2 +/- 0.4 l/kg/min, p < 0,05, and to 2.1 +/- 0.4 l/kg/min, p = NS). Mean pulmonary artery pressure, as well as pulmonary capillary wedge pressure was reduced after 3, as well as after 12 months to a statistically significant degree (MPA from 29.1 +/- 11.5 mm Hg to 23.9 +/- 10.3 mm Hg, p< 0,001, and to 24.9 +/- 11.8 mm Hg, p < 0,01 respectively, and PCWP from 19.9 +/- 9.5 mm Hg to 15.2 +/- 9.2 mm Hg, p < 0,01, and to 15.6 +/- 9 mm Hg, p < 0,01 respectively). In regard to echocardiographic parameters, there was an increase in LVEF, a reduction in the end-diastolic diameter of the left ventricle, as well as a statistically significant reduction in severity of mitral regurgitation after 3, as well as 12 months (LVEF from 20.5 +/- 5.3%, to 23 +/- 6.5%, p < 0,001, and to 24.5 +/- 8%, p < 0,001, LVEDD from 69 +/- 9 mm to 68 +/- 9 mm, p < 0.01 and to 65 +/- 12 mm, p< 0.01 respectively, mitral regurgitation from 2.2 +/- 0.8 to 1.9 +/- 0.8, p< 0.001, and to 2 +/- 0.8, p < 0.001.
In patients with chronic heart failure, resynchronization therapy leads to reduced symptoms, reduction in dyspnea and to improvements in cardiac performance due to increase in the systolic function of the left ventricle and hemodynamic changes.
评估心脏再同步化治疗对尽管接受了充分药物治疗仍有症状的慢性心力衰竭患者的疗效。
118例慢性心力衰竭患者，主要为扩张型心肌病和缺血性心脏病，伴有收缩功能减退、左心室射血分数（LVEF）降低和左束支传导阻滞伴宽QRS波群，于2000年至2006年间接受双心室系统植入。我们评估了纽约心脏协会（NYHA）心功能分级的变化、右心导管检查期间获得的血流动力学参数、运动心肺功能试验期间的最大耗氧量以及超声心动图参数。
NYHA心功能分级有统计学显著改善（3个月后从2.8±0.4改善至2.3±0.5，p<0.001；12个月后至2.5±0.6，p<0.01），运动心肺功能试验期间的最大耗氧量也增加（VO2 max从14.1±3.1 ml/kg/min增至15.3±3.1 ml/kg/min，p<0.001；至15.3±2.5 ml/kg/min，p无统计学意义）。关于血流动力学参数，三个月后心输出量和心脏指数增加。12个月后变化无统计学意义（心输出量从3.9±1 l/min增至4.2±0.9 l/min，p<0.05；至4.1±0.9 l/min，p无统计学意义；心脏指数从2±0.5 l/kg/min增至2.2±0.4 l/kg/min，p<0.05；至2.1±0.4 l/kg/min，p无统计学意义）。平均肺动脉压以及肺毛细血管楔压在3个月及12个月后均有统计学显著降低（平均肺动脉压从29.1±11.5 mmHg降至23.9±10.3 mmHg，p<0.001；至24.9±11.8 mmHg，p<0.01；肺毛细血管楔压从19.9±9.5 mmHg降至15.2±9.2 mmHg，p<0.01；至15.6±9 mmHg，p<0.01）。关于超声心动图参数，LVEF增加，左心室舒张末期内径减小，二尖瓣反流严重程度在3个月及12个月后有统计学显著降低（LVEF从20.5±5.3%增至23±6.5%，p<0.001；至24.5±8%，p<0.001；左心室舒张末期内径从69±9 mm降至68±9 mm，p<0.01；至65±12 mm，p<0.01；二尖瓣反流从2.2±0.8降至1.9±0.8，p<0.001；至2±0.8，p<0.001）。
在慢性心力衰竭患者中，心脏再同步化治疗可减轻症状、减少呼吸困难，并因左心室收缩功能增强和血流动力学改变而改善心脏功能。
