Cardiology Department, Royal Brompton Hospital, London, UK.
Int J Cardiol. 2013 Feb 20;163(2):141-5. doi: 10.1016/j.ijcard.2011.05.034. Epub 2011 Jun 12.
The experience of cardiac resynchronization therapy (CRT) in critically ill patients with cardiogenic shock or advanced heart failure is limited and inadequately described in literature.
CRT implants performed in patients on the cardiothoracic intensive care unit (ICU) at a tertiary cardiac centre during 2007-2010 were retrospectively studied.
We identified 24 patients, 17 male, of median age 76 years (IQR 11) treated with a CRT pacemaker (n=10) or CRT defibrillator (n=14). Prior to implantation median left ventricular ejection fraction (LVEF) was 26% (IQR 13) and median QRS duration 146 ms (IQR 29). Eleven (46%) patients were post elective cardiac surgery and 8 (33%) post emergency cardiac surgery or intervention with high prevalence of co-morbidities. Nineteen patients required inotropic support pre-implantation, 8 patients were on mechanical circulatory support and 18 were on mechanical ventilation. Post CRT LVEF improved from 26% to 39% (p=0.027) and the estimated glomerular filtration rate increased from 42 ml/min/1.73 m(2) (IQR 26) to 63 ml/min/1.73 m(2) (IQR 48, p=0.001). All but one patient were successfully weaned from inotropic support within a median of 4 days (IQR 5) post CRT and 22/24 (92%) survived to hospital discharge. After a median follow up of 392 days (IQR 538), 7 (33%) patients died. In-hospital and one year mortality rates were 8.3% and 29.4% respectively. Ten out of 12 patients (83%) were alive at long-term (22 ± 9 months) follow up.
CRT may assist weaning from circulatory and respiratory support in critically ill patients with left ventricular systolic dysfunction.
心脏再同步治疗（CRT）在心源性休克或晚期心力衰竭的危重症患者中的经验有限，文献中对此描述不足。
回顾性研究了 2007 年至 2010 年期间在三级心脏中心心胸重症监护病房（ICU）接受 CRT 植入的患者。
我们共确定了 24 名患者，其中男性 17 名，中位年龄 76 岁（IQR 11），使用 CRT 起搏器（n=10）或 CRT 除颤器（n=14）治疗。植入前中位左心室射血分数（LVEF）为 26%（IQR 13），中位 QRS 持续时间 146 ms（IQR 29）。11 名（46%）患者为择期心脏手术后，8 名（33%）为急诊心脏手术后或介入治疗，合并症高发。19 名患者在植入前需要正性肌力支持，8 名患者使用机械循环支持，18 名患者使用机械通气。CRT 后 LVEF 从 26%提高到 39%（p=0.027），估计肾小球滤过率从 42 ml/min/1.73 m(2)（IQR 26）增加到 63 ml/min/1.73 m(2)（IQR 48，p=0.001）。除 1 例患者外，所有患者均在 CRT 后中位时间为 4 天（IQR 5）内成功停用正性肌力支持，24 例患者中 22 例（92%）存活至出院。中位随访 392 天（IQR 538）后，7 例（33%）患者死亡。住院和 1 年死亡率分别为 8.3%和 29.4%。12 例患者中有 10 例（83%）在长期（22±9 个月）随访时存活。
CRT 可能有助于左心室收缩功能障碍的危重症患者脱机循环和呼吸支持。
