The Clinical Study On The Effect Of Advances In Echocardiography On Cardiac Resynchronization Therapy In Patients With Heart Failure

Objective:In order to abserve the improvement degree of cardiac function on cardiac resynchronization therapy in patients with chronic heart failure (CHF), we have been test synchronization of cardiac mechanical contraction by means of advanced echocardiography and try to explore wether we can predict the effect of cardiac resynchronization therapy in patients with CHF by measurement of concentration of NT-proBNP,TIMP-1,ADM, IL-6,hs-CRP in the serum,and investigated the correlation of left ventricular ejection fraction (LVEF), the serum level of NT-proBNP and the indexes of mechanical dyssynchrony, and the relationship between the DTI, the STI and the RT-3DE,and analysised the difference of survival index in patiets with a widened QRS complex group or not.Methods::①The patiets chosen by adoption standards are divided into3groups: control group(20cases), chronic heart failure with a widened QRS complex(12cases) and chronic heart failure with a shortening QRS durasion(10cases).②We evaluated mechanical dyssynchrony with the DTI, the STI and the RT-3DE as good ways of predict response after CRT and observed changes between the two groups.③The concentrasion of NT-proBNP, TIMP-1, ADM, IL-6, hs-CRP in serum have been test in Preoperation and postoperative3months to predict the effect after CRT.④To abserve the correlation of the improvement degree of cardiac function, indexes of mechanical dyssynchrony and NT-proBNP in serum level.⑤Wether or not the difference of survival index between the broad QRS group and the narrow QRS group has been analysised by the Kaplan-Meier.Result::①In CHF groups(including narrow QRS group and broad QRS group), the indexes of synchronization of cardiac mechanical contraction, the mean levels of serum NT-proBNP,TIMP-1,ADM,IL-6,hs-CRP were higher than control group (P<0.05).③However, in preoperation the indexes of mechanical dyssynchrony and the serum concentrasion of NT-proBNP,TIMP-1,ADM,IL-,hs-CRP showed no statistically significant difference between the broad QRS group and the narrow QRS group(P>0.05).③In CHF groups(including narrow QRS group and broad QRS group), the indexes of mechanical dyssynchrony and the serum levels of NT-proBNP TIMP-1,ADMx,IL-6,hs-CRP in Preoperation were greater more than them in postoperation(P<0.05).④In postoperation, the indexes of mechanical dyssynchrony and the concentrasion of NT-proBNP, TIMP-1, ADM, IL-6, hs-CRP in the serum showed no statistically significant difference between the broad QRS group and the narrow QRS group(P>0.05).⑤There are significant negative correlations between the LVEF,NT-proBNP and the indexes of mechanical dyssynchrony((P<0.001).⑥.In the indexes of synchronization of cardiac mechanical contraction, there are significant positive correlations between the DTI, the STI and the RT-3DE.⑦the difference of survival index was not statistically significant (P>0.05).Conclusion:①echocardiography is a main index to asses synchronization of cardiac mechanical contraction as a noninvasive,secure,repeatable technique. especially combined with the DTI,the STI and the RT-3DE can be complementary advances and improve the detection level.②Serum NT-proBNP, TIMP-1, ADM, IL-6, hs-CRP related with Left ventricular remodeling and initiation,process and outcome of cardiac dysfunction. Their blood levels increased along with capacity or pressure load in heart chambers and are correlated to the heart failure and heart attack postoperaton. As a result, they reflect the seriousness and the danger of CHF in a certain extent.③chocardiography can be used to screen patients,select leading location and improve the effect of CRT.