舒张功能异常是心脏再同步治疗对缺血性和非缺血性心肌病产生不同有益效果的基础。
Abnormal diastolic function underlies the different beneficial effects of cardiac resynchronization therapy on ischemic and non-ischemic cardiomyopathy.
作者信息
Wang Qi, Chen Kang-Yu, Yu Fei, Su Hao, An Chun-Sheng, Hu Yang, Yang Dong-Mei, Xu Jian, Yan Ji
机构信息
Department of Cardiology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
Cardiovascular Institute of Anhui, Hefei, China.
出版信息
Clinics (Sao Paulo). 2017 Jul;72(7):432-437. doi: 10.6061/clinics/2017(07)08.
OBJECTIVES
: To investigate the association between diastolic function and the different beneficial effects of cardiac resynchronization therapy in patients with heart failure due to different causes.
METHODS
: The 104 enrolled patients were divided into an ischemic cardiomyopathy group (n=27) and a non-ischemic cardiomyopathy group (n=77) according to the cause of heart failure. Before implantation, left ventricular diastolic function was evaluated in all patients using echocardiography. After six months of follow-up, the beneficial effects of cardiac resynchronization therapy were evaluated using a combination of clinical symptoms and echocardiography parameters.
RESULTS
: The ischemic cardiomyopathy group included significantly more patients with restrictive filling than the non-ischemic cardiomyopathy group. The response rate after the implantation procedure was significantly higher in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Degrees of improvement in echocardiography parameters were significantly greater in the non-ischemic cardiomyopathy group than in the ischemic cardiomyopathy group. Multivariate regression analysis showed that a restrictive filling pattern was an independent factor that influenced responses to cardiac resynchronization therapy.
CONCLUSIONS
: This study again confirmed that the etiology of heart failure affects the beneficial effects of cardiac resynchronization therapy and a lower degree of improvement in ventricular systolic function and remodelling was observed in ischemic cardiomyopathy patients than in non-ischemic cardiomyopathy patients. In addition, systolic heart failure patients with severe diastolic dysfunction had poor responses to cardiac resynchronization therapy. Ischemic cardiomyopathy patients exhibited more severe diastolic dysfunction than non-ischemic cardiomyopathy patients, which may be a reason for the reduced beneficial effect of cardiac resynchronization therapy.
目的
探讨舒张功能与心脏再同步治疗对不同病因心力衰竭患者的不同有益效果之间的关联。
方法
根据心力衰竭病因，将104例入选患者分为缺血性心肌病组（n = 27）和非缺血性心肌病组（n = 77）。植入前，使用超声心动图对所有患者的左心室舒张功能进行评估。随访6个月后，结合临床症状和超声心动图参数评估心脏再同步治疗的有益效果。
结果
缺血性心肌病组中限制性充盈的患者明显多于非缺血性心肌病组。植入术后非缺血性心肌病组的反应率明显高于缺血性心肌病组。非缺血性心肌病组超声心动图参数的改善程度明显大于缺血性心肌病组。多因素回归分析显示，限制性充盈模式是影响心脏再同步治疗反应的独立因素。
结论
本研究再次证实，心力衰竭的病因会影响心脏再同步治疗的有益效果，且缺血性心肌病患者心室收缩功能和重构的改善程度低于非缺血性心肌病患者。此外，严重舒张功能障碍的收缩性心力衰竭患者对心脏再同步治疗反应较差。缺血性心肌病患者的舒张功能障碍比非缺血性心肌病患者更严重，这可能是心脏再同步治疗有益效果降低的一个原因。
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