CRT-P/D治疗射血分数降低的心力衰竭患者超反应发生的相关因素分析

柴虹; 蒋周芩; 舒茂琴; 邓盛荣; 周扬; 宋治远; 李林峪

doi:10.16016/j.1000-5404.201711196

您当前的位置：

首页 >

文章列表页 >

CRT-P/D治疗射血分数降低的心力衰竭患者超反应发生的相关因素分析

临床医学 | 更新时间：2026-01-09

- CRT-P/D治疗射血分数降低的心力衰竭患者超反应发生的相关因素分析
- Analysis on factors related to super-response events in heart failure patients with reduced ejection fraction by CRT-P/D therapy
- 第三军医大学学报 2018年40卷第9期页码：810-815
- 作者机构：
  
  400038 重庆, 陆军军医大学(第三军医大学)第一附属医院心血管内科
- 作者简介：
  
  [舒茂琴, 电话:(023)68765166, E-mail:shumaoqinswh@sina.com SHU Maoqin, Tel:86-23-68765166, E-mail:shumaoqinswh@sina.com
- 基金信息：
  
  国家自然科学基金面上项目(81570396)
- DOI：10.16016/j.1000-5404.201711196
  中图分类号： R181.32;R331.31;R541.6
- 收稿：2017-11-15，
  
  修回：2018-03-12，
  
  纸质出版：2018-05-15
- 稿件说明：
移动端阅览
柴虹, 蒋周芩, 舒茂琴, 等. CRT-P/D治疗射血分数降低的心力衰竭患者超反应发生的相关因素分析[J]. 第三军医大学学报, 2018,40(9):810-815.

Hong CHAI, Zhouqin JIANG, Maoqin SHU, et al. Analysis on factors related to super-response events in heart failure patients with reduced ejection fraction by CRT-P/D therapy[J]. Journal of Third Military Medical University, 2018, 40(9): 810-815.
柴虹, 蒋周芩, 舒茂琴, 等. CRT-P/D治疗射血分数降低的心力衰竭患者超反应发生的相关因素分析[J]. 第三军医大学学报, 2018,40(9):810-815. DOI： 10.16016/j.1000-5404.201711196.

Hong CHAI, Zhouqin JIANG, Maoqin SHU, et al. Analysis on factors related to super-response events in heart failure patients with reduced ejection fraction by CRT-P/D therapy[J]. Journal of Third Military Medical University, 2018, 40(9): 810-815. DOI： 10.16016/j.1000-5404.201711196.

摘要

目的

探讨心脏再同步化治疗(cardiac resynchronization therapy with pacemaker function/defibrillation function

CRT-P/D)在射血分数降低的心力衰竭患者中发生超反应的预测因素及不良事件的影响因素。

方法

回顾分析我科2015年1月至2017年1月收治的59例因心力衰竭采用CRT-P/D治疗并随访12个月以上的患者

采集一般临床资料、心电图、心脏超声、不良事件发生等临床数据。以术后12个月左室射血分数(left ventricular ejection fraction

LVEF)升高幅度分3组:超反应组(幅度≥15%

14例)

中度反应组(5%≤幅度＜15%

23例)

轻度/无反应组(幅度＜5%

22例)。采用方差分析及多因素Logistic回归分析筛选CRT-P/D治疗发生超反应的独立预测因素。采用Kaplan-Meier法进行预后分析

COX回归模型明确影响预后的危险因素。

结果

超反应组术前心房颤动比例、右房内径(right atrial diameter

RA)明显低于中度反应组及轻度/无反应组(

0.05)

双心室起搏比例明显高于中度反应组及轻度/无反应组(

0.01)。多因素Logistic回归结果显示病程＜1.5年(

=17.54

95%

=1.41~216.96

=0.02)、RA＜35 mm(

=23.70

95%

=1.60~349.32

=0.02)、双心室起搏比例＞96%(

=36.35

95%

=12.17~609.03

=0.01)是术后发生超反应的独立预测因素。预后分析显示无事件(心衰再住院、恶性心律失常、全因死亡)生存率超反应组高于中度反应组及轻度/无反应组(Log Rank:

0.01)

多因素Cox回归分析显示对于复合不良事件的发生

心房颤动是影响预后的独立因素(

0.05

=2.35

95%

=1.067~5.19)。

结论

对于CRT-P/D治疗射血分数降低的心力衰竭患者

病程＜1.5年、RA＜35 mm

双心室起搏比率＞96%是发生超反应的重要预测因素

心房颤动是影响术后不良事件发生的独立因素。

Abstract

Objective

To analyze the influencing factors for the occurrence of super-response and adverse events in heart failure patients with reduced ejection fraction by cardiac resynchronization therapy with pacemaker/defibrillation (CRT-P/D) therapy.

Methods

A retrospective analysis was performed on 59 heart failure patients undergoing CRT-P/D therapy in our department from January 2015 to January 2017.All the patients were followed up for more than 12 months.Their general information

electrocardiogram

echocardiogram

and adverse events were collected and analyzed.According to the elevation of left ventricular ejection fraction (LVEF) at 12 months postoperatively

these patients were divided into super-response group (range ≥15%

=14)

moderate-response group (5%~15%

=23)

and mil

d/non-response group (

=22).ANOVA and multivariate logistic regression analysis were used to screen independent factors for super-response events due to CRT-P/D therapy.Kaplan-Meier analysis was adopted for prognostic analysis

and COX regression model was used to further identify the risk factors for prognosis.

Results

For the super-response group

the proportion of atrial fibrillation and the diameter of right atrial (RA) was significantly lower and smaller (

0.05)

while the proportion of biventricular pacing was obviously higher than those in the moderate-and mild/non-responde groups (

0.01).Multivariate logistic regression results showed that the disease course

1.5 years (

=17.54

95%

:1.41~216.96

=0.02)

35 mm (

=23.70

95%

:1.60~349.32

=0.02)

proportion of biventricular pacing

96% (

=36.35

95%

:12.17~609.03

=0.01) were independent prognostic factors for occurrence of super-response events after surgery.Prognostic analysis showed that there were more patients obtaining event-free survival (heart failure hospitalization

malignant arrhythmia

or all-cause death) in the super-response group than the moderate and mild/non-response groups (Log Rank

0.01).Multivariate Cox regression analysis indicated that atrial fibrillation was an independent factor for prognosis (

0.05

=2.35

95%

:1.067~5.190).

Conclusion

For the heart failure patients with reduced ejection fraction and undergoing CRT-P/D therapy

disease course < 1.5 years

RA < 35 mm

and biventricular pacing proportion >96% are important predictive factors for occurrence of super-response events.Atrial fibrillation is an independent factor for postoperative adverse events.

关键词

Keywords

references

BRIGNOLE M, AURICCHIO A, BARON-ESQUIVIAS G, et al .2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy:the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC).Developed in collaboration with the European Heart Rhythm Association (EHRA)[J ] .Europace, 2013, 15(8):1070-1118.DOI:10.1093/europace/eut206.

EPSTEIN A E, DIMARCO J P, ELLENBOGEN K A, et al .ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices):developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons[J ] .Circulation, 2008, 117(21):e350-e408.DOI:10.1161/ CI =RCUALTIONAHA.108.189742..

CLELAND J G, ABRAHAM W T, LINDE C, et al .An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure[J ] .Eur Heart J, 2013, 34(46):3547-3556.DOI:10.1093/eurheartj/eht290.

WELLS G, PARKASH R, HEALEY J S, et al .Cardiac resynchronization therapy:a meta-analysis of randomized controlled trials[J ] .CMAJ, 2011, 183(4):421-429.DOI:10.1503/cmaj.101685.

LINDE C, ABRAHAM W T, GOLD M R, et al .Predictors of short-term clinical response to cardiac resynchronization therapy[J ] .Eur J Heart Fail, 2017, 19(8):1056-1063.DOI:10.1002/ejhf.795.

EPSTEIN A E, DIMARCO J P, ELLENBOGEN K A, et al .2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J ] .J Am Coll Cardiol, 2013, 61(3):e6-e75.DOI:10.1016/j.jacc.2012.11.007.

YU C M, BLEEKER G B, FUNG J W, et al .Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy[J ] .Circulation, 2015, 112(11):1580-1586.DOI:10.1161/ CI =RCULATIONAHA.105.538272..

KILLU A M, GRUPPER A, FRIEDMAN P A, et al .Predictors and outcomes of "super-response" to cardiac resynchronization therapy[J ] .J Card Fail, 2014, 20(6):379-386.DOI:10.1016/j.cardfail.2014.03.001.

BLEEKER G B, SCHALIJ M J, BOERSMA E, et al .Does a gender difference in response to cardiac resynchronization therapy exist?[J ] .Pacing Clin Electrophysiol, 2005, 28(12):1271-1275.DOI:10.1111/j.1540-8159.2005.00267.x.

REANT P, ZAROUI A, DONAL E, et al .Identification and characterization of super-responders aft er cardiac resynchronization therapy[J ] .Am J Cardiol, 2010, 105(9):1327-1335.DOI:10.1016/j.amjcard.2009.12.058.

GASPARINI M, REGOLI F, CERIOTTI C, et al .Remission of left ventricular systolic dysfunction and of heart failure symptoms after cardiac resynchronization therapy:temporal pattern and clinical predictors[J ] .Am Heart J, 2008, 155(3):507-514.DOI:10.1016/j.ahj.2007.10.028.

YPENBURG C, ROES S D, BLEEKER G B, et al .Effect of total scar burden on contrast-enhanced magnetic resonance imaging on response to cardiac resynchronization therapy[J ] .Am J Cardiol, 2007, 99(5):657-660.DOI:10.1016/j.amjcard.2006.09.115.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

肺动脉收缩压对心脏再同步化治疗患者术后超反应及预后的影响

冠心病患者经皮冠状动脉介入治疗术后院内心力衰竭风险预测模型的建立与验证

沙库巴曲缬沙坦在射血分数下降心衰患者中的应用分析

miR-1改善异丙肾上腺素诱导的小鼠心力衰竭