心脏再同步治疗最新进展.ppt

术后优化治疗 AV优化 V-V优化 药物调整 BB、ACEI 药物上调到最大耐受剂量 使用跨二尖瓣血流进行AV优化 跨二尖瓣血流时间 经验法：在不同的AV延迟状态下评判充盈状态 “Ritter” 法.1 利用从短AV延迟和长AV延迟的优化进行公式计算 跨二尖瓣血流容量 从测试的AV延迟中选择最大的二尖瓣VTI 与介入式测得的最大 dP/dt相一致2 Too short AV delay. E and A waves separated, but A wave is truncated. Too long AV delay. E and A waves fused, filling time reduced. “Just Right” AV delay. BiV pacing sustained, active filling maintained. 1. Ritter P.. In: Fischer W, Ritter P, eds. Cardiac Pacing in Clinical Practice. Berlin: Springer Verlag; 1998:166–202. 2. Jansen AM, et al. Circulation 2003; 108:IV-488 [abs 2234] 根据主动脉VTI优化V-V 获得在不同V-V时间起搏下的左室流出道的脉冲 Doppler 选择可以产生最大VTI 的V-V间期 LV first by 4 ms LV first by 20 ms RV first by 40 ms Insync III V-V 优化可以增加每搏输出量 总结 CRT治疗可以改善生活质量、运动能力 CRT治疗可以降低全原因死亡率 CRT治疗可以逆转左室重构，减少心衰住院 Insync III 左右心室分别程控，V-V延迟功能可以部分弥补靶静脉位置欠佳的缺陷，进一步改善血液动力学 B受体阻滞剂、ACEI等药物在安装了Insync III后可以更好地调整剂量 * * Key Point: 67% of the CRT patients showed improvement in their composite response at 6-months compared to 39% of the Control patients. The difference is statistically significant. Additional Information: Unlike previous endpoints reported that analyze only those patients completing the 6 month randomization period, this measure accounts for the status of all patients randomized. The Composite Response has emerged as an important secondary endpoint of this study. It is the only endpoint, other than mortality, that takes into account all 453 patients. A patient is defined as improved if they improved 1 or more functional classes (by blinded physician), or if the patient indicated a moderate or marked improvement in the patient global assessment score. With the global assessment, the patient answers how they felt since the InSync system was implanted. There are seven possible responses: Markedly Improved, Moderately Improved, Mild Improvement, No Change, Slightly Worse, Moderately Worse, Markedly Worse. A patient is said to have worsened if they died, were hospitalized for worsening heart failure since implan