从临床病例谈顽固性心力衰竭心脏再同步CRT治疗.ppt

术后一天心电图 EF值：60% 术后两个月心超检查 有了CRT治疗就可以不需要药物治疗了吗？ CRT治疗和药物治疗的关系 CRT 治疗需在心衰标准药物治疗基础上进行 CRT 治疗可以促进药物治疗调整，如促进B受体阻滞剂等药物更好地达到靶剂量而不必过分担忧心率、血压等 INSYNC III 诊断功能可以更好地监测患者病情，调整起搏参数和药物变化。 中国心脏再同步治疗慢性心衰的建议 中华医学会心电生理和起搏分会 心脏再同步治疗专家工作组 I 类适应证 缺血性或非缺血性心肌病 充分抗心力衰竭药物治疗后，NYHA分级仍在 III级或不必卧床的IV级 窦性心律 EF≤35% QRS≥120ms 慢性心房颤动患者，合乎I类适应证的其他条件，可行有/无ICD功能的CRT治疗（部分患者需结合房室结射频消融以保证有效夺获双心室）。 充分药物治疗后心功能好转至II级， EF≤35%， QRS≥120ms。 EF≤35%，已植入心脏起搏器并心室起搏依赖者，心脏扩大及NYHA心功能III级及以上。 EF≤35%，符合常规心脏起搏适应证并预期心室起搏依赖的患者， NYHA心功能III级及以上。 IIA适应证 IIB适应证 最佳药物治疗基础上EF ≤35%、 NYHA心功能I或II级的心力衰竭患者，在植入永久起搏器或ICD时若预期需长期心室起搏可考虑植入CRT。 * * * Let’s compare our heart to this donkey, and our body to the wagon that this donkey has to pull every day. A healthy heart is like an energetic donkey, which without fatigue, pulls the wagon full of weights. Conversely, a diseased heart will have difficulty meeting metabolic demands (or pulling the wagon). * * * * * Main purpose: Establish the problem of ventricular dysynchrony. Key messages: Ventricular dysynchrony as manifested by a wide QRS is more common in patients with moderate to severe impaired ventricular systolic function (LVSF); A wide QRS is associated with a poor prognosis, and impaired cardiac function. Additional information: Masoudi and colleagues used retrospective medical chart data of 19,710 pts Medicare beneficiaries hospitalized w/ HF and for whom LV systolic function was confirmed. LBBB present in 8% of those with preserved LV systolic function (diastolic HF) and in 24% of those with EF 50% (p0.001). Aaronson developed and validated a multivariable survival model for ambulatory advanced heart failure patients wait listed for a heart transplant. IVCD (QRS 120 ms) present in 27% of the 268 pts in derivation sample, and in 53% of the 199 pts in validation sample. IVCD identified as contributing risk factor. Other studies have shown that fro the entire HF population about 15% have a wide QRS. Iuliano: 669 HF pts (ischemic or nonischemic cardiomyopathy, NYHA II