心脏再同步化治疗逆转合并左心室收缩功能不全的三度房室传导阻滞患者左心室重构的预测因素分析

摘要

目的:分析合并左心室收缩功能不全的三度房室传导阻滞(AVB)患者应用心脏再同步化治疗(CRT)后发生左心室重构逆转的预测因素.方法:选取2009-01至2015-05在安徽省立医院植入CRT的三度AVB患者65例,收集术前临床资料及术后随访资料,术后12个月左心室收缩末期容积(LVESV)较术前下降≥15%或左心室射血分数(LVEF)增加≥5%定义为左心室重构逆转.将患者分为逆转组(n=36)和无逆转组(n=29),比较两组患者的临床资料,并采用二分类Logisitic回归模型分析CRT逆转左心室重构的预测因素.结果:共入选患者65例,平均年龄(62±14)岁,随访12个月,发生心室重构逆转的患者为36例(55.4%),逆转组女性(P=0.011)、基线QRS时限>120 ms(P=0.001)、心室间激动延迟(IVMD)≥40 ms(P=0.027)、心率校正后的心电图Q波起始点距离左心室16节段最小容积点时间间隔的标准差[Tmsv16-SD(%R-R)]≥8.3%(P=0.001)的比例高于无逆转组,二元Logisitic回归分析显示,女性(OR=6.228,95%CI:1.561~24.842,P=0.01)、QRS时限>120 ms(OR=7.778,95%CI 1.996~30.769,P=0.003)与Tmsv16-SD(%R-R)≥8.3%(OR=8.134,95%CI:2.064~32.057,P=0.003)是心室重构发生逆转的独立预测因素.结论:对于合并左心室收缩功能不全的三度AVB患者,女性、QRS时限>120 ms及Tmsv16-SD(%R-R)≥8.3%或可作为CRT逆转左心室重构的预测因素.%Objective: To analyze the predictors of left ventricular reverse remodeling in patients with III? atrio-ventricular block (AVB) combining left ventricular systolic dysfunction after cardiac re-synchronization therapy (CRT). Methods: A total of 65 III? AVB patients received CRT in our hospital from 2009-01 to 2015-05 were enrolled. Clinical information before and after the operation were recorded. Left ventricular reverse remodeling was deifned by left ventricular end systolic volume (LVESV) decreased 15% or left ventricular ejection fraction (LVEF) increased≥5% at 12 months after CRT. The patients were divided into 2 groups: Reversal group,n=36 and No reversal group,n=29. Clinical condition was compared between 2 groups, predictors for CRT reversing left ventricular remodeling were evaluated by two classiifcation Logistic regression analysis. Results: The patients' average age was (62±14) years and 36/65 (55.4%) with reverse remodeling. In Reversal group, the ratios of female (P=0.011), baseline QRS width>120ms (P=0.001), inter-ventricular mechanical delay (IVMD)≥40 ms (P=0.027) and standard deviation of time-to-minimum systolic volume of 16 segments [Tmsv16-SD (%R-R)≥8.3%, (P=0.001)] were higher than those in No reversal group. Two classiifcation Logisitic regression analysis indicated that female (OR=6.228, 95%CI 1.561-24.842, P=0.01), QRS duration>120 ms (OR=7.778, 95% CI 1.996-30.769,P=0.003) and Tmsv16-SD (%R-R)≥8.3% (OR=8.134, 95% CI 2.064-32.057,P=0.003) were the independent predictors for ventricular reverse remodeling . Conclusion: Female, QRS>120ms and Tmsv16-SD (%R-R)≥8.3% could be used as the predictors for CRT reversing left ventricular remodeling in III? AVB patients combining left ventricular systolic dysfunction.