The Analysis Of Relationship Between Body Mass Index And Cardiac Resynchronization Therapy

BackgroundsAs the terminal stage of the various causes cardiovascular disease development, Chronic congestive heart failure(CHF) has high incidence, hospitalization rate and mortality. In the past few decades for the treatment of chronic congestive heart failure is mainly used strong heart, diuresis and expand blood vessel drugs such as symptomatic heart failure drugs support treatment, although drug therapy for heart failure has made great achievements, but there are still some patients with heart failure in heart failure with normal after drug treatment, clinical symptoms and cardiac function, no obvious improvement, the majority of patients with atrioventricular synchronization, sync or between left and right ventricular heart indoor contract out of sync. With the continuous development of medical technology and innovative research, since the 1990 s, cardiac resynchronization therapy(cardiac resynchronization therapy CRT) for the treatment of chronic congestive heart fell and perfect a new type of non-drug therapy method by cognitive and gradually accepted, it is primarily through the heart pacemaker technology coordination of atrial and ventricular excited, keep left and right ventricular synchrony and indoor excited, improve heart function, reduce mitral regurgitation, and reversal of myocardial remodeling, improve exercise tolerance of patients, reduce hospitalization rate and mortality. Although the position in the field of CRT in the treatment of heart failure is increasing day by day, but still many large clinical studies have shown that about 20% ~ 30% of the CRT patients implanted characterized by state, namely cannot benefit from CRT. In recent years, the western developed countries, the proportion of obesity is high and the developing countries with the improvement of quality of life and eating habits gradually westernized, proportion of obesity is rising year by year, obesity not only as an independent disease, at the same time as the related risk factors for a variety of metabolic disease. But studies have shown that with the increase of body mass index(bmi), but lower risk for patients with chronic heart failure, namely \ "obesity paradox\", obesity is helpful for heart failure in patients with ventricular reverse remodeling and long-term prognosis. CRT without reply judging criteria currently used mainly NYHA heart function classification, 6 min walking distance, left ventricular ejection fraction, such as lack of unified curative effect evaluation standard and predict CRT response index. Therefore, further research which measures can be used to predict the CRT without reply has important clinical and practical significance. Obesity as one of a variety of metabolic disorders and cardiovascular disease risk factors, whether with the CRT curative effect has certain relevance, whether can be used as predictors of the CRT without reply is still in exploring study. ObjectiveBody mass index(BMI)is one of line in fat main judging criteria. through a retrospective analysis of cardiac resynchronization therapy in patients with body mass index, analysis of the correlation of body mass index and CRT without reply, at the same time analysis the correlation of body mass index and other CRT curative effect evaluation index, the selection for CRT indication and forecast the curative effect of CRT after implantation provide a simple and effective. Methods1. This study is a retrospective cross-sectional study, selected from June 2009 to June 2014 in the first affiliated hospital of zhengzhou university heart medicine in the hospital for patients with chronic congestive heart failure line of CRT implanted.2. Collect the history, record the basic information of the patients with CRT before implantation: gender, age, height, weight, NYHA heart function classification, the fundamental cause, 6 min walking distance and time limit of QRS wave and left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), left ventricular end systolic volume(LVESV), left ventricular end-diastolic volume(LVEDV), left atrial diameter(LAD) and plasma sodium forebrain peptide(NT- pro- BNP).3. The postoperative follow-up for at least six months, according to any reply after implanted CRT is divided into the CRT response Results1. A total of 95 patients, postoperative follow-up of at least 6 months, mean follow-up of 14.5 ± 12.9 months, 95 cases of patients, 5 patients were lost to follow-up, the remaining 90 patients were included in this study, CRT response group 74 cases, the proportion is 82.2%, 5 cases died, compared with 5.6%, 3 cases died of heart failure, 2 cases died of cerebral hemorrhage, are included in the CRT no response group, CRT no answer group of16 cases.2. CRT patients with response group and no answer basic data comparison: the two groups in gender, age, smoking history, diabetes history, causes, 6 min walking distance, duration of QRS wave, NYHA heart function classification, left ventricular end-diastolic volume and left ventricular end systolic volume and Log(NT- pro-BNP) no statistically significant differences(P > 0.05), and two groups of body mass index, left ventricular ejection fraction and left atrial diameter and left ventricular end-diastolic volume differences are significant(P < 0.05).3. Will the CRT response groups according to BMI level into underweight groups(BMI < 18.5 kg/m2), the normal weight group(18.5 kg/m2 or less BMI < 24.0 kg/m2), overweight(24.0 kg/m2 or less BMI < 28.0 kg/m2) and obese group(BMI acuity 28.0 kg/m2), each percentage is 20%,26.7%,35.6%,17.7%.respectively, each comparison results as follows: underweight and overweight and obese group between difference(P < 0.05); Between normal-weight and overweight and obese groups had difference(P < 0.05) there was no statistically significant difference between overweight and obesity(P > 0.05).(3) the correlation between BMI and various clinical indicators analysis shows: the BMI and gender, etiology, smoking history, history of diabetes, heart function NYHA classification were positively correlated, r value were 0.700, 0.730, 0.718, 0.668, 0.177. BMI and age, 6 min walking distance, left atrial diameter(LAD), left ventricular end-diastolic volume(LVEDV), left ventricular end systolic volume(LVESV) showed a negative correlation, r value respectively 0.336, 0.334, 0.405, 0.380 and 0.188.4. The object of this research is divided into four groups according to BMI(as mentioned above), the clinical data of 4 set of comparison, the results showed that four groups in gender, smoking history, causes, 6 min walking distance, duration of QRS wave, NYHA heart function classification, left ventricular ejection fraction, the Log(NT- pro- BNP) the distribution of differences has no statistical significance(P > 0.05), and four groups of age, diabetes history, left ventricular end-diastolic volume and left ventricular end systolic volume number, there are significant difference between left atrial diameter distribution(P < 0.05).5. With age, sex and BMI, LAD, LVEF, LVEDV, QRS wave time limit, such as 6 min walking distance to the independent variable, CRT has without reply as dependent variable, a Logistic regression analysis, the results show that the BMI, LAD, LVEF is associated with the CRT response. Conclusionbasic body mass index and CRT response after implantation rate has certain correlation, within a certain range, with the increase of body mass index, CRT no answer after the implantation rate reduced. BMI can be a predictor of CRT without reply.