Analysis Of Nonresponse To Cardiac Resynchronization Therapy In Patients With Type Ⅰ Indication

Objection:To Analysis of cardiac resynchronization therapy in patients with type Ⅰ indications of postoperative non-response predictors.Screening more suitable for cardiac resynchronization therapy patients,Improve response rate,but also to avoid the waste of medical resources.Methods:A total of 89 patients with CRT undergoing heart failure in the First Hospital of Da Lian Medical University during June 2010 to June 2017 were enrolled in this study.In the 89 patients,28 with atrial fibrillation,Non-left bundle branch block in5 cases,LVEF> 35% in 6 cases,remove the above total of 39 patients.The remaining 50 patients had complete preoperative and postoperative data and were followed up for at least 6 months.All patients met the Class I indications of the 2012 European Society of Cardiology guidelines for acute and chronic heart failure CRT,included in the study.The age,sex,height,weight,body mass index(BMI),preoperative and postoperative QRS wave group time,preoperative and postoperative left ventricular ejection fraction,left atrial diameter,preoperative and postoperative left ventricular end diastolic diameter,Lymphocyte percentage,hemoglobin,heart failure time,PR interval,brain natriuretic peptide,serum creatinine,neutrophil percentage,platelet lymphocyte ratio,neutrophil lymphocyte ratio,distribution width of red blood cells,myocardial infarction,Diabetes mellitus,dilated cardiomyopathy,true left bundle branch block,mitral regurgitation,left ventricular electrode distance(including left anterior oblique 45 °,right anterior oblique30 °and anteroposterior position),left and right ventricular lead position.All patients were followed up for at least 6 months,and standard echocardiography and New York Heart Association(NYHA)were assessed 6 months after surgery.Six months after operation,LVEF was ≥15% higher than preoperative and NYHA grade ≥1 was considered as CRT response.Did not meet the above two criteria defined as CRT nonresponse.Retrospective analysis of the indicators between the two groups,comparing the differences between the two groups.P <0.05 considered the difference was statistically significant.Result:A total of 50 patients were enrolled in this study,including 19 males(51.4%),34 cases of dilated cardiomyopathy(91.9%),17 cases of left bundle branch block(17.5%)and 5 cases with a left lead in apex(10%).Age,sex,height,weight,BMI,preoperative LVEF,LAD,preoperative and postoperative LVEDD,lymphocyte percentag,,Hb,heart failure time,PR interval,BNP,SCr,The percentage of neutrophils,PLR,NLR,RDW,MI,HTN,DM,heart disease,TLBBB and MR were not significantly different in response and non-response.There was a significant difference between the two groups in preoperative and postoperative QRS wave group time difference(P =0.047),LAO45 ° left and right ventricular lead distance(P = 0.04)and left ventricular lead position(P = 0.033).LVEDD improvement in patients with dilated cardiomyopathy was greater than that in non-dilated cardioplegia,P <0.05.The improvement of LVEF and LVEDD in patients with LBBB was better than that in patients without LBBB.Conclusions:1.Preoperative and postoperative difference in QRS wave timing and LAO45°left and right lead distance is an independent risk factor for CRT response,The smaller preoperative and postoperative difference in QRS wave timing and LAO45°left and right lead distance are predictors of CRT non-response.2.TLBBB is a strong predictor of normal heart function after CRT.3.The left ventricular lead in the apex may be a predictive factor for CRT nonresponse.