Influence Factors Of Response For Cardiac Resynchronization Therapy In Patients With Heart Failure

Objective: To investigate the influence factor of response for CRT (cardiacresynchronization therapy) in patients with heart failure.Methods: Retrospective analysis the clinical data in patients with heartfailure, who received cardiac resynchronization therapy in our hospital fromMarch2012to December2013,20patients were treated in accordance withthe CRT Ⅰ class indication of CRT guidelines. All patients were completedelectrocardiogram, echocardiogram, BNP, biochemical tests (includinghypersensitive c-reactive protein, renal function, etc.) and had theoptimization of treatment, such as β-blockers, ACEI, ARB and diureticsbefore CRT implanted. Implanted successfully the CRT. Set ventriculareffective pacemaker above90%, optimize the CRT after the operation7daysand the AV/VV after the operation3months. Recorded the information ofpatients including gender, age, primary disease heart type, whether withdiabetes. completed3months follow-up to all patients. Improved indicatorsincluding clinical symptoms, signs, QRS duration and some echocardio-graphic parameters before and after the operation3months. On the basis ofthese parameters were compared with preoperative, clinical symptomsimproved and grade of cardiac function improvement one level and above,LVEDV down by at least15%, we divided all patients into the CRT reactiongroup (group A) and CRT non-response group (group B).Result: Among the20cases of patients, male15cases, female5cases,aged from41to75years old, average (61.1+8.4) years old,7cases withischemic cardiomyopathy,13cases with ischemic cardiomyopathy,15caseswith complete left bundle branch block, diabetes or glucose toleranceabnormal in9case, GFR abnormal (GFR <125ml/min) in7cases. Measuredaverage BNP497.4±435pg/ml,GFR112.2±28.6ml/min,Hs-CRP8.12±14.5md/L, NYHA3.45±0.51. Including15cases with NYHA above from3.47±0.51to1.87±0.64, LVEDV fall from227.53±65.68to82.60±52.65ml, who aredefined as the CRT response group (group A). The other5patients show noimprovement with the above indicators, defined as no reaction group (groupB). Efficient rate is75%after the operation3months. ComparedLVEDD,LVEDV,LVEF and QRS duration postoperative3months with thosepreoperative, group A were improved significantly (P<0.05)，LVEDD fallfrom67.6±8.24to61.13±8.27mm,LVEDV fall from227.53±65.68to82.60±52.65ml, LVEF above from27.39±5.68to37.02±6.25%,QRS durationfrom0.158±0.021to0.142±0.175ms;While the improvement is not obviousin group B(P>0.05). Logistic regression analysis showed that: diabetes,ischemic cardiomyopathy, GFR drop, Hs-CRP rise are the risk factors for CRTnon-response (P<0.05).Conclusions: The CRT is effective for treatment of chronic heart failure.Diabetes, ischemic cardiomyopathy, GFR drop, Hs-CRP rise are the riskfactors for CRT non-response.