白求恩国际和平医院.ppt
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1、,CRT-D超反应者更换时的选择: CRT-D还是CRT-P?,白求恩国际和平医院,王冬梅 2012-3-17,猝死的主要相关因素 CRT-P/D超反应定义及发生率 CRT-D的电击治疗状况 CRT-P/D的相关问题 CRT-D更换的选择,一、猝死的主要相关因素,心衰患者的猝死率1,2,3,4,1 MERIT-HF Study Group.Effect of metroprolol CR/XL in chronic heart failure.Lancet.1999;353:2001-2007. 2 CIBIS Investigations and Committees.The cardiac
2、 insufficiency bisprolol study II (CIBIS-II).Lancet.1999;353:9-13. 3 Packer M,Bristow MR,Cohn JN,et al.The effect of carvedilol on morbitity and nortality in patients with chronic heart failure.U.S.Carvedilol Heart Failure Study Group.N Engl J Med.1996;334:1349-1355. 4 The RALE Investigators.Effecti
3、veness of spironolactone added to an aniotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure(the Randomized Aldactone Evaluation StudyRALES.Am J Cardiol.1997;78:902.,1 Gorgels, PMA Out-of-hospital cardiac arrest-the relevance of heart failure.The Maastr
4、icht Circulatory Arrest Registry.European Heart Journal.2003;24:1204-1209.,LVEF,% SCA Victims,7.5%,5.1%,2.8%,1.4%,LVEF与SCA的相关性1,SCA危险性增加了5倍,心衰伴频发室早,SCA风险更高,Maggioni AP. Circulation. 1993;87:312-322.,Oregon Sudden Unexpected Death Study (SUDS),2011AHA, Dr Sumeet S Chugh,111 例 ,mean age 69 years, coro
5、nary disease ,ICD10%,ICD protection likely needed, even if LVEF improves,二、CRT-P/D超反应定义及发生率,302例,随访22 11个月( 6 to 53),发生率 判定标准 负反应:22% LVESV 无应答:21% LVESV 0% 14% 有应答: 35% LVESV 15% 29% 超应答:22% LVESV 30%,JACC Vol. 53, No. 6, 2009,Long-Term Prognosis After CRT Is Related to the Extent of Left Ventricul
6、ar Reverse Remodeling at Midterm Follow-Up,JACC Vol. 53, No. 6, 2009,判定标准 无应答:LVEF 无改善 有应答:LVEF 10% 超应答:LVEF15 %,340 例,Age : 69 10 years 56 % ICM NYHA class 3.1 0.5 19 % PAF QRS duration : 156 34 ms 89 % with LBBB LVEF : 28 6.5 %,Pascal Defaye, MD, Cardiology Department, University Hospital of Greno
7、ble, Grenoble, France,Long-term follow-up of 340 patients with CRT: predisposing factors of super-response,结 果,无应答:84 例 (25%) 有应答:194 例 (57%) ,(包括45 例NYHA 心功能降低和住院次数减少,但LVEF 没达标 ) 超应答:62 例 (18%),Pascal Defaye, MD, Cardiology Department, University Hospital of Grenoble, Grenoble, France,Basal Left Ve
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