CRT Chronic Heart Failure And Narrow QRS Duration In Patients With Efficacy And Effects On Cytokines

Objectives:Cardiac resynchronization therapy(CRT) is the common devices that benefits patients with advanced heart failure. The aim of this study is to observe the short-term(12months after therapy)effect of CRT in patients with a widened QRS complex group or not who have congestive heart failure, to investigate the change of setum cytokines in these patients and the relationship between cytokines and heart failure.Methods:Twenty-four patients(mean age59.2±12.8years)with New York Heart Association (NYHA) class Ⅲ(n=17)or IV(n=7), Left ventricular end-diastolic dimention(LVEDD)≥55mm, Left ventricular ejection fraction(LVEF)<35%, and QRS duration>120ms(n=16)or QRS duration<120ms(n=8) were divided into3groups,16patients with QRS duration≥120ms received biventricular pacing therapy and optimal medical therapy including diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, βblockers, spironolactone, digoxin and4patients patients with QRS duration<120ms received biventricular pacing therapy and optimal medical therapy including diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, βblockers, spironolactone, digoxin and the other4patients with QRS duration<120ms received the same optimal medical therapy. Investigations were performed before(at baseline)and3month,6month,12month respectively after CRT together with optimal medical therapy or optimal medical therapy alone.They include Minnesota Living with Heart Failure questionnaire for quality-of-life assessment, echocardiography(to survey LVEF、 LVEDD, SPWMD, IVMD, Ts-SD-12, Tm sv16-SD%). The blood of the3groups was collected before breakfast to measure serum level of BNP、NT-proBNP、IMP-1、ADM、IL-6、hsCRP. Meanwhile, the mortality andrehospitalization rate of the3groups were observed.Results:(1). Mortality and rehospitalization rate:No death occurred at12month follow-up in two groups who implanted CRT, and one death in the group who not implanted CRT and only received the optimal medical therapy,and3 rehospitalization because of heart failure deterioration in QRS duration<120ms group, but none in CRT group.(2). Heart function. quality of life:At3month,6month and12month follow-up. NYHA class, the quality of life scores, were improved in CRT group compared with baseline values(P<0.05-0.01); the patients received biventricular pacing therapy and optimal medical therapy(with QRS duration≥120ms)including diuretics compared with patients received biventricular pacing therapy and optimal medical therapy(with QRS duration<120ms)including diuretics have no baseline values (P>0.12～0.35); the patients received biventricular pacing therapy and optimal medical therapy(with QRS duration<120ms)including diuretics compared with QRS duration<120ms received the same optimal medical therapy only, with baseline values (P<0.05～0.01)。(3)Echocardiographic measurement:At3month,6month and12month follow-up, LVEF was improved in CRT group compared with baseline values(P<O.05～0.01),and compared with that in contrast group(P<O.05). LVEDD, SPWMD(ms), IVMD(ms), Ts-SD-12(ms), Tm sv16-SD%in CRT group was improved too compared with baseline values(P<0.05～0.01). and compared with that in contrast group who QRS duration<120ms received the same optimal medical therapy only (P<0.05) at12month follow-up.(4)Serum cytokine concentration:At6month follow-up, The serum BNP^NT-proBNP、IL-6、hsCRP concentration were tend to decrease in CRT group,could not achieve statistical difference(P>0.05). The serum TIMP-1and ADM concentration were tend to increase in CRT group, achieve statistical difference(P<0.05). The serum BNP、NT-proBNP、TIMP-1、ADM、IL-6、hsCRP concentration were tend to good in CRT group(P<0.01). The serum BNP、TIMP-1、ADM、 NT-proBNP、IL-6、hsCRP concentration at baseline,at3month,6month and12month follow-up all had a significant negative correlation witll LVEF(P<O.05～0.01).Conclusion:CRT,a pacemaker-based therapy for heart failure, helps to correct hemodynamic disturbance,enhances quality of life and heart function.reduces rehospitalization rate and reverses LV remodeling. CRT can change serum cytokine BNP、NT-proBNP、TIMP-1、ADM、IL-6、hsCRP concentration.and it indicates that BNP、NT-proBNP、TIMP-1、ADM、IL-6、hsCRP concentration can be looked as index of predicting heart function in patients with CHF.