再同步治疗的挑战和思考-课件演示文稿.pptVIP

DAVID 试验结论 DAVID 试验显示对于没有起搏适应证（AV传导正常）的LVEF≤40%的ICD治疗患者，双腔起搏过高的心室起搏比例，增加死亡率和心衰住院率。 Ongoing Studies BLOCK HF Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block (continued) Key Inclusion Criteria AV block NYHA Class I, II, or III LVEF ≤ 50% First-time implant of CRT-P or CRT-D To receive CRT-D, must be indicated for an ICD * * 再同步治疗的挑战和思考 王东琦 西安交通大学医学院第一附属医院 Evidence For Heart Failure 在美国，每年因心衰就诊3.4百万，死亡30万。 一年再住院率50%，中重度心衰年死亡率近30%。 ≥65岁者患病率6~10%。 QRS≥120ms患者全因死亡率增加约33%。 …… Evidence For CRT EF≤35%， QRS≥120ms ， 经理想药物治疗, NYHA III~IV : 提高心功能分级，改善生活质量，增加活动耐量。 降低死亡率和住院率。 提高生存率。 如何让更多患者受益？ IMPROVE HF To examine patient and cardiology practice characteristics predictive of CRT use in eligible patients in an outpatient registry of systolic heart failure patients Fonarow GC, et al. Circ Heart Fail. 2008;1:98–106. Percent of Indicated Patients (%) Percent of Indicated Patients Receiving CRT (CRT-D/CRT-P) at Baseline IMPROVE HF Baseline Performance on CRT All Practices (Baseline Review) 39.39% Fonarow GC, et al. Circ Heart Fail. 2008;1:98–106. IMPROVE HF Registry Less than 40% of CRT-eligible patients received a device at baseline assessment ? In 1/3 of IMPROVE HF outpatient practices, not a single eligible patient received a CRT device at baseline 手术成功率 在RCTS纳入的4000多例中，CRT（经CS植入LV电极技术）的成功率88％－92％： 鞘管难以插入CS 冠状静脉狭窄或闭锁 难以进入靶血管分支或脱位 膈肌刺激 115° 135° Amp CS 60° Straight 115° 60° 135° Amp CS Non-responder, true or false ? 40 consecutive CRT-D patients admitted to Cleveland Clinic HF ICU Met CRT indications at implant Implanted for at least 3 months (mean 19 months) Increased LVEDV from pre-implant baseline Averaged 1.2 HF hospitalizations 87.5% with LV lead in lateral or postero-lateral position Biventricular paced 96% of time Acute, serial echo and invasive hemodynamic measurements in CRT ON and CRT OFF modes Hidden benefit: when CRT turned off, hemodynamic, ECG echo parameters worsened PCWP P 0.001 Cardiac Out