Effectiveness And Risk Factors Of Cardiac Resynchronization Therapy In Patients With Chronic Heart Failure

Objective:To investigate the short-term clinical efficacy and related risk factors of death of cardiac resynchronization therapy in patients with refractory heart failure.Methods:A total of thirty-nine patients with refractory heart failure while undergoing cardiac resynchronization therapy in the first hospital of jilin university from January 2010 to August 2015 were retrospectively analyzed, all patients were measured before operation and six month after operation of cardiac function(NYHA classification), duration of QRS wave, some echocardiographic parameters including left atrial diameter(LAD), left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), mitral regurgitation area, through the contrast before and after treatment, to explore the short-term clinical efficacy of triple chamber pacemaker in patients with refractory congestive heart failure. And carries on the long-term follow-up, the selected patients were divided into survival group and death group.Analyzed and compared with multiple factors such as age, sex,susceptible factors(high blood pressure, diabetes, hyperlipidemia), the type of the primary disease of heart failure, the duration and morphology of QRS wave, cardiac function, echocardiography related indicators and so on, respectively. To assess the risk factors of death in patients after CRT.Results:1. Echocardiographic indicators : Six months after surgery,patients’ left ventricular ejection fraction(LVEF) have increased obviously and have significant difference compared with preoperative(P<0.05). And patients’ left atrial diameter, left ventricular end diastolic diameter(LVEDD) have reduced compared with preoperative, the difference was statistically significant. Mitral regurgitation area have no significant difference compared with before surgery.2. Electrocardiogram : The QRS duration has obvious shortened compared with before and six months after treatment, the difference was statistically significant(P<0.05).3. Cardiac function : After six months patients’ New York cardiac function(NYHA classification) has been improved compared with before operative, the difference was statistically significant.4. The comparison and analysis results of the two groups shows:diabetes and left atrial diameter have statistically significant difference between the two groups(P < 0.05),suggesting that these factors may be the risk factors of death in patients after CRT.5.The areas under the ROC curve of left atrial diameter is 0.752(95%CI : 0.583-0.921), the cut-off value is 49.5mm, if left atrial diameter greater than 49.5mm, suggesting that the risk of death increased significantly in patients after CRT.Conclusions:1.Double ventricular resynchronization pacemaker therapy can make the heart function significantly improved in patients with refractory heart failure, the left ventricular ejection fraction increased significantly, the left ventricular end diastolic diameter, left atrial diameter decreases obviously, the QRS duration shortened obviously.2.Heart failure patients with diabetes, left atrial diameter increases may be the risk factors of death in patients after CRT.3.The left atrial diameter have a moderate predictive value of the risk of death in patients with heart failure after CRT.