| Cardiac resynchronization therapy(CRT) was risen in the1990s as a heart failure ofnon-drug therapy means,its use cardiac pacemaker improve heart failure patients withconduction anomaly, restore the heart electric mechanical synchronous, improve cardiacstructure and function,for the treatment of chronic heart failure initiated a new way. Athome and abroad, the latest heart failure and implanted devices guidelines, all has thecombined with cardiac contraction not synchronous (especially with complete left bundlebranch block) of symptomatic heart failure as a class I indication for cardiacresynchronization therapy. Rheumatic heart disease valve replacement after the surgery,heart serious refactoring, electrical and mechanical structure. Lead to lower quality of life,hemodynamic deterioration, because it can’t cure in patients with heart failure in late stageof clinical, repeated hospital drug therapy effect is not obvious. Rarely reported in theliterature at home and abroad cardiac resynchronization therapy rheumatic heart diseasevalve replacement after chronic severe heart failure, so in order to evaluate cardiacresynchronization therapy rheumatic heart disease after valve replacement of chronicsevere heart failure curative effect,we conducted three parts test research.First part Objective: To research on cardiac resynchronization therapy rheumatic heartdisease after valve replacement of chronic revere left heart failure of two dimensionalechocardiography evaluation. Methods: Choose from Mar2009to July2012in ourdepartment in hospital accord with standards of36chronic severe heart failure patient ofcardiac resynchronization therapy. The rheumatic heart disease after valve replacement13cases (trial group),control group23cases. Age from24years to76years(56.81±11.64),women14cases, men22cases. Collect all patients detail disease history, make sure theyare diagnosed chronic heart failure. Record preoperative6months after surgery and12months the main parameters of ultrasonic inspection. Two groups of echocardiographyduration of follow-up was valve group19.46±13.17months, control group19.65±12.98months(P=0.967). Results: Two-dimensional ultrasound follow-up results showedthat:1.Left ventricular ejection fraction: valve group6months postoperatively comparedwith preoperative increased (36.38±10.39%vs27.75±5.82%,p=0.14), comparedpostoperative12months with postoperative6months has a tendency toincrease(43.16±15.62%vs36.38±10.39%，P=0.69),postoperative12months compared withpreoperative improved significantly(43.16±15.62%vs27.75±5.82%,p=0.039). In controlgroup after6months,12months were significantly improved compared with preoperative(37.81±9.87%vs27±7.04%,p=0.001;41.27±12.71vs27±7.04%,p<0.001), comparedpostoperative12months with postoperative6months has a tendency toincrease(41±12.71%vs37.81±9.87%，P=0.81);each time there were no significantcompared with preoperative (preoperative:25±7.44vs26.7±7.04%, p=0.5;postoperative6months:31.6±11.79%vs37.09±10.27,p=0.13; postoperative12months: 45±15.88%vs38±13.85%,p=0.3).The valve group of CRT,LVEF have continued toimprove,and have the same well curative effect with control group.2.The left ventricularend-diastolic diameter: There was no significant difference compared with preoperative(7.16±1.16cm vs7.0±1.16cm,p=0.75), compared postoperative12months withpostoperative6months has a tendency to decrease(6.10±1.21vs7.16±1.16,P=0.89),compared postoperative12months with preoperative decreased13%,(6.10±1.21cm vs7.0±1.16cm, p=0.32). The control group after6months,12monthscompared with preoperative decreasing trend (6.52±1.37cm vs6.74±1.35cm,p=0.56;6.72±1.22cm vs6.74±1.35cm,p=0.43), there was no significant difference between twogroups at each time (preoperative:7.0±1.16cm vs6.74±1.35cm,p=0.56; postoperative6months:7.16±1.16cm vs6.52±1.37cm, p=0.18; postoperative12months:6.10±1.21cmvs6.72±1.22cm,p=0.29).3.Left atrial diameter: valve group6months postoperativelycompared with preoperative increased (5.03±1.39cm vs5.01±0.71cm, p=0.96),and12months postoperatively compared with preoperative decreasing trend (4.95±0.75cm vs5.01±0.71cm,p=0.9), postoperative12months with postoperative6months has a tendencyto decrease(4.95±0.75cm vs5.03±1.39cm cm,p=0.90);in the control group after6months,12months after operation compared with preoperative decreasing trend (4.46±0.81cm vs4.65±0.92cm,p=0.76;4.32±1.12cm vs4.65±0.92cm,p=0.26), postoperative12monthscompared with postoperative6months there was no significant difference(4.32±1.12cmvs4.46±0.81cm，P=0.92), compared preoperative with postoperative6months between thetwo groups, valve group significantly greater than the control group(preoperation:5.29±0.81cm vs4.66±0.9cm,p=0.045; postoperative6months:5.21±1.21cmvs4.47±0.79cm,p=0.037),and12months postoperatively compared between the twogroups no significant difference (4.94±0.82cm vs4.61±1.0cm, p=0.47),left atrial diametervalve group has a decreasing trend,and has the same well curative effect with controlgroup.4.Tricuspid regurgitation:6months、12months after operation in valve groupcompared with preoperative have increased (5.81±7.52ml vs4.35±5.94ml, p=0.68;7.5±7.54ml vs4.35±5.94ml, p=0.38);6months,12months postoperative in controlgroup compared with preoperative has no significant difference (4.35±4.51ml vs6.68±4.81ml, p=0.12；4.53±5.36ml vs6.68±4.81ml,p=0.15);Each time there was nosignificant difference between the two groups (7.26±7.09ml vs6.75±4.71ml,p=0.26；10.61±11.62ml vs5.27±6.24ml, p=0.86;8.75±9.68ml vs4.53±5.36ml, p=0.14).Conclusions: Two-dimensional echocardiographic follow-up results suggest cardiacresynchronization therapy for severe left heart failure in improving LVEF,decreaseLVEDd, LAD, promote heart reverse remodeling,prevent the tricuspid regurgitation isaggravating, play an important role for these aspects, valve group and control group inthese areas can get the same benefits.Second part Objective: Use6minutes walk test evaluation of CRT rheumatic heartdisease curative effect of chronic severe left heart failure after valvular replacement.Methods: Choose in March of2009to July2012hospitallized in our department in accordance with criteria for the line of36patients with chronic severe heart failure cardiacresynchronization therapy.13cases of rheumatic heart disease after valve replacementgroup, control group of23cases. Preoperative and postoperative3,6,12months6minuteswalk test.Two sets of follow-up time is19.46±13.17months vs19.65±12.98months,p=0.967. Results:6minutes walking test distance: valve group3months afteroperation compared with preoperative increased (227.25±133.26m vs132.25±92.89m,p=0.41),after6months,12months, the preoperative significant increase (263.25±141.71mvs132.25±92.89m, p=0.046;328.5±127.91vs132.25±92.89,p=0.004),postoperative6months compared with postoperative3months,compared postoperative12months withpostoperative6months,all have increasing trend(263.25±141.71m vs227.25±133.26m,P=0.96;328.5±127.91vs263.25±141.71m, P=0.78); control group after3,6,12months were significantly increased compared with preoperative walking distance(278.18±77.12m vs175±87.72m, p<0.001；355.73±56.79m vs175±87.72m,p<0.001;396.91±85.93m vs175±87.72m,p<0.001),compared postoperative6months with postoperative3monthshave significant difference(355.73±56.79m vs278.18±77.12m, P=0.011),CRT resultsshow that the control group obviously improved after6minutes walking distance,toincrease amplitude during3to6months after surgery; preoperative and postoperative3months between the two group of walking distance. Compared the control groupsignificantly longer than the valve group(179.91±8.88m vs98±87.64m，p=0.012；275.65±75.67m vs167.54±141.4m，p=0.017),6and12months postoperatively,walking distance differencebetween the two groups was not significant(355.73±56.79m vs263.25±141.71m, p=0.11；396.91±85.91m vs328.5±127.91m,p=0.102). Conclusions: Follow-up results show twogroups of patients after treatment with the CRT,6minutes walking distance weresignificantly improved, although chronic atrial fibrillation and valve group history of liverand kidney function failure,but6minutes walking distance increased always shows a goodtrend,the statistical results show that valve group can get the same benefit with controlgroup.Third part Objective: Using plasma BNP level evaluation of cardiac resynchronizationtherapy rheumatic heart after valve replacement the clinical curative effect of chronicsevere left heart failure. Methods: Choose in March of2009to July2012hospitalized inour department in accordance with criteria for the line of36patients with chronic severeheart failure cardiac resynchronization therapy.13cases of rheumatic heart disease aftervalve replacement group, control group of23cases. Preoperative and postoperative3、6、 12months the plasma BNP level. Follow-up time for valve group19.46±13.17months vscontrol group19.65±12.98months,p=0.967. Results: The plasma BNP levelfollow-up:valve group after3months,6months after operation compared withpreoperative a downward trend(1708.38±1100.75pg/ml vs1806.25±994.96pg/ml, p=0.84;992.5±842.18pg/ml vs1806.25±994.96pg/ml, p=0.09), the results of12months comparedwith preoperative has decreased significantly(739.31±765.07pg/ml vs1806.25±994.96pg/ml,p=0.03),postoperative6months compared with postoperative3months has adecreased trend(992.5±842.18pg/ml vs1708.38±1100.75pg/ml，P=0.07),postoperative12months compared with postoperative6months has no significantdifference(739.31±765.07pg/ml vs992.5±842.18pg/ml); the control group after3monthscompared with preoperative has a downward trend(415.84±908.12pg/ml vs1460.95±857.31pg/ml, p=0.87), postoperative6months compared with postoperative3monthshas a decrease trend(906.11±804.56pg/ml vs1415.84±908.12pg/ml，P=0.108),postoperative12months compared with postoperative6months also has a decrease trend(516.55±889.88pg/ml vs906.11±804.56pg/ml,P=0.069),postoperative6months,12months compared with preoperative significantly reduced(906.11±804.56pg/ml vs1460.95±857.31pg/ml,p=0.04；516.55±889.88pg/ml vs1460.95±857.31pg/ml,p=0.001);All time is no significant difference between the two groups(preoperative:2011.46±937.19pg/ml vs1612.61±1025.98pg/ml, p=0.26；3months postoperative：1883.62±1136.89pg/ml vs1556.2±1057pg/ml,p=0.39；6months postoperative：1422.5±1190.35pg/ml vs901.29±785.49pg/ml, p=0.15；12months postoperative：739.3±765.07pg/ml vs516.55±889.88pg/ml, p=0.538).Conclusions: Plasma BNPresults show that the CRT in two groups after treatment of severe left heart failure patients,plasma BNP level were significantly reduced, valve group for12months with preoperativeplasma BNP level were significantly lower, suggesting CRT for valve group can beobtained after12months of treatment and control group in terms of plasma BNP reduceequally remarkable curative effect.Summary: Rheumatic heart disease after valve replacement by CRT in patients with severeleft heart failure after1year can be raised in LVEF and improve myocardial remodeling,6minutes walking distance,lower plasma BNP level attained remarkable curative effect,butwith one CRT clear indications of DCM also benefit. |
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