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目的观察慢性收缩性心力衰竭(SHF)患者心脏收缩不同步的类型、发生比例,探讨QRS时限>135 ms对心脏再同步化治疗(CRT)术前病例筛选的价值。方法45例入选的SHF患者根据QRS时限分为:宽QRS组(QRS≥120 ms,n=24),窄QRS组(QRS<120 ms,n=21),采用体表心电图、常规超声心动图和组织多普勒来评价各组患者心脏收缩不同步的情况;以135 ms作为截断值,评价优化的QRS时限对SHF患者心脏机械收缩不同步的诊断价值。结果心功能指标:与窄QRS组相比,宽QRS组患者LVEDD、LVEDV升高(P=0.03、0.01),LVEF降低(P=0.004);宽QRS组患者NYHA分级升高(P=0.002),利尿剂及洋地黄类药物使用率明显增加(P=0.01)。心脏机械收缩不同步指标:与窄QRS组相比,宽QRS组患者室间不同步比例明显升高(70.8%vs15%,P<0.000 1),IVMD值亦明显升高(P<0.000 1);宽、窄QRS组患者室内不同步发生率均较高(79.2%vs71.4%),组间无统计学差异(P=0.55);宽QRS组APET显著延长(P<0.000 1);两组患者其余指标(Ts-SD、Ts-12、SPWMD等)均无统计学差异。相关性分析显示:QRS时限与室间不同步发生显著相关(r=0.58,P<0.000 1),但与室内不同步却相关不明显(r=0.07,P=0.64)。ROC曲线分析:以QRS时限>135 ms诊断室间不同步的敏感性和特异性分别为80%和87.5%;但评价室内不同步的敏感性为44.1%,特异性为73.6%。结论SHF患者人群存在较高比例的心室机械收缩不同步;QRS时限>135 ms能较好地评价心室间机械收缩不同步,可能对优化CRT术前病例筛选有一定价值。
Objective To investigate the types and incidence of asystole in patients with chronic systolic heart failure (SHF), and to explore the value of screening QRS duration of> 135 ms in preoperative cardiac resynchronization therapy (CRT). Methods Forty-five SHF patients were divided into two groups: wide QRS group (QRS≥120 ms, n = 24) and narrow QRS group (QRS≤120 ms, n = 21) And tissue Doppler to evaluate the systolic asynchrony in each group. The cut-off value of 135 ms was used to evaluate the diagnostic value of optimal QRS duration in the diagnosis of cardiac systolic asynchrony in SHF patients. Results: In the QRS group, LVEDD and LVEDV increased (P = 0.03, 0.01) and LVEF decreased (P = 0.004) , Diuretics and digitalis significantly increased the use of drugs (P = 0.01). Cardiac mechanical contractions were not synchronized: Compared with the narrow QRS group, the rate of interventricular asynchrony was significantly increased in patients with wide QRS (70.8% vs15%, P <0.0001) and IVMD (P <0.0001) (P <0.0001). In wide and narrow QRS group, the incidence of in-hospital asynchrony was higher (79.2% vs 71.4%), with no significant difference between the two groups (P = 0.55) The rest of the group of patients (Ts-SD, Ts-12, SPWMD, etc.) were not statistically different. Correlation analysis showed that QRS duration was significantly correlated with interventricular asynchrony (r = 0.58, P <0.0001), but not correlated with indoors (r = 0.07, P = 0.64). ROC curve analysis: Sensitivity and specificity of QRS duration> 135 ms for diagnosis of inter-ventricular asynchrony were 80% and 87.5%, respectively; but the sensitivity and specificity of non-synchronized evaluation of indoors were 44.1% and 73.6%, respectively. Conclusion There is a high proportion of ventricular mechanical contractions in patients with SHF asynchrony. QRS time> 135 ms can evaluate ventricular contraction asynchronously and may be of value in optimizing preoperative CRT screening.