Observation And Analysis Of Response To Postoperative CRT/CRTD In Patients With Chronic Heart Failure

Objective:By collecting the basic clinical data of patients with chronic heart failure who received CRT/CRT-D in our hospital,observe the response distribution of cardiac resynchronization therapy in our hospital,discuss the possible influence factors of the therapeutic effect of cardiac resynchronization.Methods:The clinical data of patients with chronic heart failure treated by cardiac resynchronization for the first time from November 2007 to November 2017 were retrospectively collected.The patients were followed up regularly by means of readmission,outpatient service,telephone and home visits,and the proportion of response distribution was observed.The possible predictors of the therapeutic effect of cardiac resynchronization and the existing problems were analyzed.Results:1.A total of 18 patients were enrolled.There were 14 males and 4 females,63.11 ±9.68 years old.There were 10 cases of ischemic cardiomyopathy and 8 cases of non-ischemic cardiomyopathy.4 cases in NYHA class II,9 cases in class III,5 cases in class IV;Complete left bundle branch block 15 cases;1 case with atrial fibrillation);complete right bundle branch block with left anterior branch block 1 case;complete atrioventricular block,sick sinus node syndrome with atrial fibrillation,double chamber pacemaker implantation upgrade 1 case;One case had delayed sinus ventricular conduction.According to the Chinese Heart Failure Guidelines of 2018,the indications of cardiac resynchronization therapy for 18 patients in our hospital were composed of 12 patients with class Ia indication,1 patient with class Ib indication,3 patients with class IIa indication and 2 patients with class IIb indication.The overall response rate of our hospital is 55.56%(10/18 cases),and 66.66%(8/12)of patients with type Ia were responsed,83.33%(10/12)of patients responsed after 12-36 months later re-evaluated,1 case of patients with type Ib responsed,66.66%(2/3)of patients with type IIa responsed,and none of patients with type IIb responsed.2.Compared with the clinical baseline data of the non-responding group,the RDW in the responding group was significantly smaller than that in the non-responding group(12.07 ±2.05 vs 14.87 ±1.44,Z=-2.981,P=0.003).The QRS wave duration in the responding group was shorter than that in the non-responding group(174.06 ±21.19 Vs 200.41 ±32.44,Z=-1.676,P=0.007),and the difference was statistically significant;the female response rate was 100%(4/4cases),male.Male response rate was 42.85%(6/14 cases).There was no significant difference between male and female using Fisher accurate probability chi-square test(P=0.092).3.The average EAARN score of all patients was 1.15±1.21.The patients were evaluated as low-risk patients with 12 patients,3 patients dead;The evaluation was performed in 5 middle-risk patients,and one patient dead;one patient was evaluated as high-risk,and NYHA class recovery in II at the last follow-up.4.This study showed that left ventricular ejection fraction and left ventricular short axis shortening rate were significantly higher than those before surgery after cardiac resynchronization therapy.The difference was statistically significant(T=-2.71,P=0.015;T=-2.25,P=0.039),left ventricular end-diastolic volume and left ventricular end-systolic volume were significantly lower than those before surgery,the difference was statistically significant(T=2.14,P=0.049;T=2.39,P=0.03),and left ventricle Although the diastolic diameter was lower than that before surgery,the difference was not statistically significant(P>0.05).The LVEF and LVFS were further improved after 12-36 months after cardiac resynchronization treatment,and the difference was statistically significant(T=-6.67,P=0.000;T=-3.20,P=0.002).Immediately after CRT,3-6months after CRT,12-36 months after CRT the QRS wave duration was significantly shorter than that before surgery,and the difference was statistically significant(Z=-4.92,P<0.001;Z=-4.83,P < 0.001;Z =-2.69,P = 0.007);and the QRS wave duration shortening was most pronounced immediately after surgery.5.Baseline QRS wave duration,RDW were negatively correlated with reactivity(r=-0.351,P=0.009;r=-0.727,P<0.001);famale was positively correlated with reactivity(r=0.508,P<0.001).Conclusion:1.Cardiac resynchronization therapy can reverse cardiac remodeling,the therapeutic effect persisted with the course of disease.2.The baseline RDW could be used as a predictor of the therapeutic effect of cardiac resynchronization.3.Shortening of the QRS wave duration after surgery in patients with cardiac resynchronization may predict response.