摘要目的 应用超声心动图观察心脏再同步治疗(CRT)后不同时期AV、VV间期优化对心力衰竭血流动力学的影响,探讨AV、VV间期优化在增强CRT临床疗效中的作用.方法 扩张性心肌病心力衰竭患者32例接受CRT治疗,并于植入术后7 d,3、6个月在超声心动图指导下进行AV、VV间期优化,观察优化后不同时间起搏参数、血流动力学指标.结果 32例入选患者均一次成功植入三腔起搏器,术后1、3、6个月随访起搏阈值、感知、阻抗的改变差异无统计学意义(P>0.05).CRT植入术后7 d,87%(28/32)、90%(29/32)患者分别需要AV、VV间期优化,植入术后6个月仍有18%(6/32)、16%(5/32)患者分别再次需要AV、VV间期优化.植入术后7 d、3个月优化起搏与术后未优化相比,舒张期充盈时间(DFT)延长、Tei指数下降(P<0.05).植入术后6个月优化起搏与植入术后即刻相比DFT延长、主动脉瓣前向血流速度时间积分(VTI)增加、Tei指数下降、E/Em比值下降、左心室射血分数(LVEF)明显增加(P<0.05).结论 CRT植入术后AV、VV间期优化改善心力衰竭患者的血流动力学,可以带来良好的临床疗效.

abstractsObjective To assess the hemedynamic effects of cardiac resynchronization therapy(CRT) with atrio-ventricular (AV)、interventricular (VV) delay optimization by echocardingram and evaluate the im-provement of clinical therapy in patients with AV、VV delay optimization in CRT. Methods Thirty-two dilated cardiomyopathy patients with severe heart failure were treated with CRT. All patients were regularly performed AV、VV delay optimization on 7th day,3rd month and 6th month after CRT. During the follow-up, hemedynamics by echocardiogram and pacing parameters were studied. Results All patients were implanted pacemaker suc-cessfully. No significant changes were observed in threshhold, sense and impedence on the 1th month, the 3rd month and the 6th month optimization (P>0.05). Twenty-eight cases were optimized AV delay (87%) and 29 cases were optimized VV delay (90%) on the 7th day after CRT. Meanwhile,AV delay was reoptimized in 6 ca-ses (18%) and VV delay was reoptimized in 5 cases (16%) on the 6th month after CRT. Diastolic filling time (DFT) increased significantly and Tei index decreased significantly (P<0.05 respectively) compared with pre-optimization. DFT, aortic velocity time integral (VTI), Tei, E/Em and LVEF were significantly ameliorated (P<0.05) on the 6th month after AV、VV delay optimization. Conclusion AV、VV delay optimization after CRT can improve the hemodynamics and clinical effects in patients with refractory heart failure.