The Influence Factors Of Hyper-responsiveness In Patients With Hronic Heart Failure To Cardiac Resynchronization Therapy

Objective:This study surveyed and analysed its clinical features,devices data and medication situations of patients with chronic congestive heart failure implanted cardiac resynchronization therapy pacemaker or defibrillator,and collected the cardiac function indexes,program optimization situations and major adverse cardiovascular events at postoperative follow-up,discussed the influence factors of hyper-responsiveness.Methods:This study screened 38 patients with CHF who were admitted to the department of cardiovascular medicine at the first affiliated hospital of medical college of zhejiang university from June 2017 to June 2018 and received CRT treatment,regularly completed a half-year follow-up with complete data.To collected baseline data such as general situations,cardiac function indexes,medical histories,basic disease states,laboratory indexes,heart structure and function parameters of echocardiography,ECG parameters,medication situations,equipment types and program control parameters at the time of admission,and regularly followed up the cardiac function indexes,program optimization situations and major adverse cardiovascular events after 1,3 and 6 months after implanted CRT.All patients underwent echocardiography review at six months.Patients were divided into CRT response group and CRT hyper-reaction group according to CRT reactivity and their respective corresponding baseline or follow-up data were compared.Univariate and multivariate binary logistic regression analysis was used to explore the factors affecting CRT hyper-responsiveness.Reasults:1.This study enrolled 38 patients,including 20 males(52.6%)and 18 females(47.4%).The lowest age was 37,the highest age was 88,and the mean age was 64.5±10.0 years.The distribution types of cardiomyopathy were:dilated cardiomyopathy in 34 cases(89.5%,NYHA classification was 3.2±0.4),ischemic cardiomyopathy in 4 cases(10.5%,NYHA classification was 2.8 ± 0.96).2.According to the definition of CRT reactivity in this study,22 patients met the definition of CRT hyper-reactivity.Compared with the CRT reaction group,the differences in the following indicators in the CRT hyper-reaction group were statistically significant:in baseline data,preoperative NYHA classification was higher,the proportion of ICM was lower,the proportion of t-CLBBB was higher,the proportion of non-CLBBB(RBBB/IVCD)was lower,and left ventricular quadrupole wire implantation was higher.Follow-up data showed that,the CRT super-reaction group showed more apparent improvement of NYHA class,a trend of continuous improvement of cardiac function,lower proportion of heart failure deteriorate once it got better,more apparent improvement of LVEF,the number of f-QRS leads numbers decreased significantly,and the proportion of acute treatment events associated with heart failure and combined endpoint events was lower.In addition,the LAD,LVEDD,pulmonary artery systolic blood pressure,and proportion of mitral valve moderate and above regurgitation was significantly improved at six months after surgery compared with that before surgery in the CRT hyperreaction group,while there was no statistically significant difference in these indicators in the CRT response group.Single factor analysis found that the history of ischemic cardiomyopathy was the influencing factors to reduce the super-reaction of the CRT,and the higher NYHA clas sification,t-CLBBB type of bundle branch block and quadrupole leads implantation were the influencing factors to increase the super-reaction of the CRT.Multivariate regression analysis showed that the history of ischemic cardiomyopathy were independent factors to reduce CRT hyper-responsiveness,while t-CLBBB type of bundle branch block and quadrupole wire implantation were independent factors to increase CRT hyper-responsiveness.Conclusions:3.The cardiac function of CRT responders may deteriorate again half a year after implantation,while the cardiac function of CRT hyper-responders can maintain a stable and good state.Multivariate regression analysis showed that the history of ischemic cardiomyopathy were independent factors to reduce CRT hyper-responsiveness,while t-CLBBB type of bundle branch block and quadrupole wire implantation were independent factors to increase CRT hyper-responsiveness.