文档介绍:心脏再同步化治疗心力衰竭CRT-----HF
心力衰竭的定义
在足够体液容量、心率及充盈压下,由于心输出量下降导致的一系列综合征。表现为:运动耐量下降、呼吸困难、体液潴留。
心力衰竭的发病率
与其他疾病不同,心力衰竭的发病率d as left bundle branch block
结构: disruption of myocardial collagen matrix impairing electrical conduction and mechanical efficiency
机械运动: Regional wall motion abnormalities with increased workload and stress—compromising ventricular mechanics
心脏再同步
Therapeutic intent of atrial synchronized biventricular pacing
Modification of interventricular, intraventricular, and atrial-ventricular activation sequences in patients with ventricular dysynchrony
Complement to optimal medical therapy
1 Tavazzi L. Eur Heart J 2000;21:1211-1214
心室内和心室间传导延迟(IVCD)的发生率
1 Havranek E, Masoudi F, Westfall K, et al. Am Heart J 2019;143:412-417
2 Shenkman H, McKinnon J, Khandelwal A, et al. Circulation 2000;102(18 Suppl II): abstract 2293
3 Schoeller R, Andersen D, Buttner P, et al. Am J Cardiol. 1993;71:720-726
4 Aaronson K, Schwartz J, Chen T, et al. Circulation 2019;95:2660-2667
5 Farwell D, Patel N, Hall A, et al. Eur Heart J 2000;21:1246-1250
IVCD 15%
IVCD >30%
总的心衰人群1,2
中到重度的心衰人群3,4,5
QRS Duration (msec)
<90
90-120
120-170
170-220
>220
QRS宽度 –死亡率成比例地增加
NYHA Class II-IV patients
3,654 ECGs digitally scanned
Age, creatinine, LVEF, heart rate, and QRS duration found to be independent predictors of mortality
Relative risk of widest QRS group 5x greater than narrowest
1 Gottipaty V, Krelis S, Lu F, et al. JACC 2019;33(2) :145 [Abstr847-4].
Vesnarinone Study1(VEST study analysis)
心室失同步的临床后果
1 Grines CL, Bashore TM, Boudoulas H, et al. Circulation 1989;79:845-853.
2 Xiao, HB, Lee CH, Gibson DG. Br Heart J 1991;66:443-447.
3 Xiao HB, Brecker SJD, Gibson DG. Br Heart J 1992;68:403-407.
4 Yu C-M, Chau E, Sanderson JE, et al. Circulation. 2019;105:438-445.
室间隔运动异常1
dP/dt减少3,4
EF 和 CO减少4
心室舒张时间减少1,2,4
二尖瓣反流增加1,2,4
心脏再同步化治疗
目标:
心房同步双心室起搏,左心室通过冠状窦获心外膜起搏
心脏再同步化治疗
治疗策略
100%心室起搏达到心脏再同步化
提供心房跟踪,达到理想的频率适应
优化(最大化)心室充盈
心脏再同步化治疗
方法;
心外膜途径
需要开胸
增加相应的死亡率
经