Cardiac Resynchronization Of The Treatment Of Postoperative Recurrent Right Heart Failure In Patients With Clinical Features And Analysis

Part I Valuation of right ventricular function in patients with repeated right ventricular failure after cardiac resynchronization therapy【Objective】To valuate right ventricular function in patients with repeated right ventricular failure after cardiac resynchronization therapy (CRT) and retrospectively analyze the potential predictor.【Methods】The clinical data of 11 patients who developed repeated right ventricular failure (RVF group) and 11 patients without RVF (non-RVF group) after CRT was analyzed retrospectively. RV dimension, pulmonary artery pressure (PAP) and tricuspid peak velocity (Sa) were collected by two-dimensional echocardiography and Tissue Doppler Imagine. The predictor of repeated RVF after CRT is analyzed by Logistic regression method.【Results】After an average of 43.0±12.8 months follow-up, in comparison with non-RVF group, patients of RVF group are characterized by larger RV dimension (43.6±5.9mm vs 34.2±2.9mm , p<0.001), higher PAP ( 45.9±18.7mmHg vs 26.3±7.6mmHg,p=0.007) and decreased Sa (6.2±1.3cm/s vs 9.7±2.5cm/s,p=0.001). PAP in the patients of RVF group significantly increased at 3 months after CRT(35.5±11.2mmHg vs 50.5±15.8mmHg, p=0.002).On the contrary, PAP in the patients of non-RVF group significantly decreased at 3 months after CRT (29.0±9.4mmHg vs 22.4±3.5mmHg,p=0.026). In Logistic regression analysis, PAP (p=0.041, OR=1.555) at the 3-month follow-up after CRT was the independent predictor for repeated RV failure. The Receiver-Operating Curve (ROC) showed PAP over 30mmHg could predict repeated RV failure with 90.9% sensitivity and 100% specificity.【Conclusion】The repeated RV failure after CRT was characterized by enlarged right ventricular dimension, elevated PAP and decreased tricuspid peak velocity. PAP over 30mmHg at 3 months after CRT can predict repeated RV failure after CRT. PartⅡThe characteristic of plasma N-terminal Brain natriuretic peptide level in patients with repeated right ventricular failure after cardiac resynchronization therapy【Objective】To retrospectively analyze the characteristic of N-terminal Brain natriuretic peptide in patients with repeated right ventricular failure after cardiac resynchronization therapy.【Methods】The data of 22 patients received cardiac resynchronization therapy were summarized and analyzed retrospectively, including 11 patients with repeated right ventricular failure (RVF) and 11 patients without RVF(non-RVF group). Two-dimensional echocardiography and tissue Doppler were used to measure RV dimension, pulmonary artery pressure (PAP) and tricuspid peak velocity (Sa). The plasma NT-proBNP was detected by immunoassay.【Results】The plasma NT-proBNP level was obviously higher in patients of RVF group than that in the patients of non-RVF group (log10^NT-proBNP 3.64±0.46ng/L vs 3.12±0.56ng/L,p=0.028). The plasma NT-proBNP level did not significantly change after CRT in RVF group (log10^NT-proBNP3.60±0.42ng/L vs 3.64±0.46ng/L,p=0.871);The plasma NT-proBNP level in non-RVF group decreased after CRT without significant difference (log 10NT-proBNP 3.38±0.47ng/L vs 3.12±0.56ng/L,p=0.151)。The plasma NT-proBNP level in RVF group has no correlation with both left ventricular end-diastolic diameter (LVEDD)(r=-0.275,p=0.414)and left ventricular ejection fraction(LVEF)(r=-0.392,p=0.234). Multivariate regression analysis suggests LVEF(β=-0.517,p=0.004)and pulmonary artery pressure (PAP) (β=0.416,p=0.017) are two independent parameters for the elevated plasma NT-proBNP level after CRT.【Conclusion】The plasma NT-proBNP level in patients with repeated right ventricular failure after CRT remains relatively high. PAP and LVEF are two independent factors for the elevated plasma NT-proBNP level in CRT patients.