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目的 :探讨右心导管肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)与心脏再同步化治疗(cardiac resynchronization therapy,CRT)慢性心衰疗效的相关性。方法:入选拟行心脏再同步化治疗的慢性心衰患者,术前1周内进行右心导管检查,测定肺毛细血管楔压;根据CRT术后患者心功能变化分成CRT有反应组与无反应组。术后6个月内左室射血分数(LVEF)提高超过5%,纽约心功能分级(NYHA)降低1级或1级以上者定义为CRT有反应;通过受试者工作曲线分析PCWP对CRT反应性的预测价值。应用Kaplan-Meier生存曲线分析不同水平PCWP患者主要心血管不良事件的差异。结果:35例CRT患者中有反应24例,无反应11例;有反应组PCWP(11.9±7.0)mm Hg,无反应组PCWP(21.7±9.1)mm Hg,两组间差异有统计学意义(P=0.006)。以PCWP 12.0 mm Hg为最佳分界点时,Youden指数最大,预测CRT反应性的敏感度为90.9%,特异度为58.3%。相对于PCWP>12.0 mm Hg组,PCWP≤12.0 mm Hg组CRT术后心功能、左室内径和PCWP更佳。Kaplan-Meier生存曲线表明PCWP≤12.0 mm Hg组患者比PCWP>12.0 mm Hg组患者无主要心血管不良事件的生存时间长,但未达到统计学差异(P=0.079)。结论:术前右心导管检测PCWP对CRT反应性有较好的预测价值。术前PCWP低的患者无主要心血管不良事件的生存时间长。
Objective: To investigate the relationship between right capillary catheter pulmonary capillary wedge pressure (PCWP) and cardiac resynchronization therapy (CRT) in patients with chronic heart failure. Methods: Right heart catheterization was performed within 1 week before surgery to determine the pulmonary capillary wedge pressure. According to the changes of cardiac function in patients with CRT after CRT, patients with chronic heart failure were divided into CRT-responsive group and non-responsive group group. The LVEF increased by more than 5% within 6 months after operation, and NYHA class 1 or class 1 was defined as CRT response. PCWP was analyzed by receiver operating curve The predictive value of reactivity. Kaplan-Meier survival curves were used to analyze differences in major cardiovascular adverse events in patients with different levels of PCWP. Results: Among the 35 CRT patients, 24 cases responded and 11 cases did not respond. PCWP (11.9 ± 7.0) mm Hg in response group and 21.7 ± 9.1 mm Hg in non-response group were significant differences between the two groups P = 0.006). The Youden index was the largest at PCWP 12.0 mm Hg, with a sensitivity of 90.9% and a specificity of 58.3% for predicting CRT responsiveness. Relative to PCWP> 12.0 mm Hg group, PCWP≤12.0 mm Hg group CRT cardiac function, left ventricular diameter and PCWP better. Kaplan-Meier survival curves showed that patients in the PCWP ≤12.0 mm Hg group had longer survival but no significant difference (P = 0.079) longer than those in the PCWP> 12.0 mm Hg group without major cardiovascular adverse events. Conclusion: Preoperative right heart catheterization of PCWP has good predictive value for CRT reactivity. Patients with low preoperative PCWP had no major cardiovascular adverse events with long survival.