Clinical Evaluation And Analysis Of Non-Response Of Cardiac Resynchronization Therapy In Patients With End-Stage Chronic Heart Failure

Objective: To explore the clinical outcomes and non-response reasons and in chronic heart failure patients with cardiac resynchronization therapy.Methods: Collecting and chronic heart failure patients in our hospital between January2009 and August 2018,on the basis of strictly drug therapy treatment above 3 months,in New York heart association(NYHA)class III-IV,after the best drug treatment there are still in progress or(and)for serious heart failure symptoms or signs defined as end-stage heart failure,conform to the 6 minutes walking distance < 450 m(accord with standard of clinical moderately severe heart failure),with Left ventricular ejection fraction(LVEF)<35% and left ventricular end-diastolic diameter(LEVDD)> 55mm;24 patients in the CRT group and 28 patients in the non-CRT group were screened out.The average age of patients in the CRT group was 64.92±9.90 years old,including 19 males(79.17%).The average age of patients in the non-CRT group was 59.64± 12.14 years old,including 19 males(67.85%).The two groups of patients need to record the BNP-level,heart rate,NYHA classification,creatinine values,ejection fraction,LVEF,LEVDD,LVESD data from on admission to 12 months follow-up period,other information including the basic diseases,merge etiology,QRS wave length and morphology,sinus rhythm,level of pulmonary hypertension,electrode placement positions,the choice of the CRT or CRT-D,then make comparison and evaluation comprehensively,follow-up time nodes are before treatment,after treatment 1 week,6 months and 12 months all the datas are retrospectively analyzed.Results: Follow-up was conducted 1 week,6 months to 12 months after the treatment.NYHA grading,B-type natriuretic peptide(BNP),LVEF,left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD),QRSD in the CRT group were statistically different after CRT implantation surgery(P < 0.05).There were statistically significant differences in LVS and heart rate between the non-CRT group and the non-CRT group 1 week after treatment and 6 months after drug treatment(P<0.05).No statistical difference was found in QRSD,LVD,NYHA grading and EF values of the non-CRT group 6 months after drug treatment compared with 1 week and 1 week before drug treatment respectively.According to the clinical outcomes of CRT,there were 18 cases of responders and 6 cases of non-responders(2 cases died),and the response rate was1/3.Multiple factors regression analysis showed that the CRT responders are for complete left bundle branch block(C-LBBB)and QRS wave length > 0.13 s,basic renal function(creatinine acuities>133 umol/L)related to the reaction(P < 0.05),renal insufficiency,electrocardiogram(Ecg)for right bundle branch block(RBBB)or the rest of the left bundle branch block behavior,the influence factors including pulmonary hypertension to the Non-response for CRT may be related.Conclusion: CRT in patients with end-stage heart failure in clinical treatment effect is superior to simple drug treatment group,in which non-responesed relevant factors are non-LBBB?the QRS wave and width(QRS<0.13s)?renal insufficiency(creatinine acuities> 133umol/L),and whether the merger of atrial fibrillation and the level of pulmonary hypertension may influence the CRT responsing.