本文選題：心臟再同步治療 + 房室傳導(dǎo)阻滯�。� 參考：《中國循環(huán)雜志》2017年08期

【摘要】：目的:分析合并左心室收縮功能不全的三度房室傳導(dǎo)阻滯(AVB)患者應(yīng)用心臟再同步化治療(CRT)后發(fā)生左心室重構(gòu)逆轉(zhuǎn)的預(yù)測因素。方法:選取2009-01至2015-05在安徽省立醫(yī)院植入CRT的三度AVB患者65例,收集術(shù)前臨床資料及術(shù)后隨訪資料,術(shù)后12個月左心室收縮末期容積(LVESV)較術(shù)前下降≥15%或左心室射血分數(shù)(LVEF)增加≥5%定義為左心室重構(gòu)逆轉(zhuǎn)。將患者分為逆轉(zhuǎn)組(n=36)和無逆轉(zhuǎn)組(n=29),比較兩組患者的臨床資料,并采用二分類Logisitic回歸模型分析CRT逆轉(zhuǎn)左心室重構(gòu)的預(yù)測因素。結(jié)果:共入選患者65例,平均年齡(62±14)歲,隨訪12個月,發(fā)生心室重構(gòu)逆轉(zhuǎn)的患者為36例(55.4%),逆轉(zhuǎn)組女性(P=0.011)、基線QRS時限120 ms(P=0.001)、心室間激動延遲(IVMD)≥40 ms(P=0.027)、心率校正后的心電圖Q波起始點距離左心室16節(jié)段最小容積點時間間隔的標準差[Tmsv16-SD(%R-R)]≥8.3%(P=0.001)的比例高于無逆轉(zhuǎn)組,二元Logisitic回歸分析顯示,女性(OR=6.228,95%CI:1.561~24.842,P=0.01)、QRS時限120 ms(OR=7.778,95%CI 1.996~30.769,P=0.003)與Tmsv16-SD(%R-R)≥8.3%(OR=8.134,95%CI:2.064~32.057,P=0.003)是心室重構(gòu)發(fā)生逆轉(zhuǎn)的獨立預(yù)測因素。結(jié)論:對于合并左心室收縮功能不全的三度AVB患者,女性、QRS時限120 ms及Tmsv16-SD(%R-R)≥8.3%或可作為CRT逆轉(zhuǎn)左心室重構(gòu)的預(yù)測因素。
[Abstract]:Aim: to analyze the prognostic factors of left ventricular remodeling after cardiac resynchronization in patients with three degree atrioventricular block (AVB) complicated with left ventricular systolic dysfunction. Methods: Sixty-five patients with CRT implanted in Anhui Provincial Hospital from January 2009 to May 2015 were selected and their clinical data and follow-up data were collected. After 12 months left ventricular end-systolic volume (LVESVV) decreased by more than 15% or left ventricular ejection fraction (LVEF) increased by 鈮，

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