摘要目的 接受心脏再同步治疗(CRT)的慢性心力衰竭患者中,部分患者心脏结构和功能显著改善,甚至可以恢复至接近正常,即所谓的超级反应患者(super-responders,SR),本文回顾分析这些超级反应患者的临床特征,寻找有价值的CRT超级反应患者的预测指标.方法 2005年6月至2010年1月在本中心因慢性心力衰竭植入CRT-P/CRT-D的患者共69例,其中有较完整随访资料的50例纳入本研究.CRT超级反应患者判断标准为左心室射血分数(LVEF)绝对值增加≥0.20.回顾性分析50例患者中超级反应患者和非超级反应患者的临床特征,比较两组患者之间的差异.结果 平均随访时间(13.9±11.5)个月,达到超级反应标准患者11例(22%),与术前相比LVEF显著升高(0.58±0.05对0.33±0.05,P<0.001).超级反应组和非超级反应组术前资料除性别(女性比例:8/11对11/39,P=0.013)、QRS时限[(163.2±19.3)ms对(140.2±29.1)ms,P=0.018]、左束支阻滞的比例(10/11对20/39,P=0.04)外差异无统计学意义.多元logistic回归分析显示女性合并完全性左束支阻滞是CRT超级反应的惟一独立预测因子.结论 CRT中超级反应患者以女性、QRS时限增宽以及合并左束支阻滞患者多见.女性合并左束支阻滞是CRT超级反应的独立预测因子.

abstractsObjective Some patients with chronic heart failure who undergo cardiac resynchronization therapy(CRT),the so-called super-responders(SR),experience a dramatic response to CRT,their heart function improved significantly,and even retum to near normal.The purpose of this study was to find valuable clinical attributes of CRT super-responders.Methods Sixty-nine patients had implanted a CRT/CRT-D device between June 2005 and January 2010 in our center.We reviewed clinical and lab data of 50 patients who had complete follow-up data.Patients whose absolute LVEF improved by 0.20 or more were termed super-responders.Clinical characteristics of these 50 patients were analyzed retrospectively,the difference between the two groups were compared.Results The average follow-up time was 13.9±11.5 months.In this cohort of 50 patients.11 (22%)met criteria for super-responders,their LVEF was significantly higher(0.58±0.05 vs 0.33±0.05,P<0.001)than before.Super-responders group and non-super-responders group had significant difference in gender(female ratio:8/11 vs 11/39,P=0.013),QRS width[(163.2±19.3)ms vs(140.2±29.1)ms,P=0.018]and left bundle branch block ratio(10/11 vs 20/39,P=0.04).There was no other significant difference between two groups.Multiple logistic regression analysis showed that woman combined with complete left bundle branch block is the only independent predictor of CRT super-responden Conclusion Cardiac resynchronization therapy super-responders are more common in female patients with widened QRS wave,and with left bundle branch block.Woman with left bundle branch block is an independent predictor of super responders to CRT.