Analysis Of Clinical Response To Cardiac Resynchronization Therapy In Patients With Chronic Heart Failure And True Complete Left Bundle Branch Block

ObjectiveTo verify if the patients with chronic heart failure which conform to the newlytrue complete left bundle branch block diagnostic criteria have a better clinical andinstrumental response to cardiac resynchronization therapy.MethodFrom2010March to2013July, the chronic heart failure patients treated withCRT were selected as the research object in the department of Cardiology of theSecond Affiliated Hospital of Zhengzhou University and the Seventh people’sHospital of Zhengzhou City.According to the t-CLBBB, traditional CLBBB andnonspecific intraventricular conduction disturbances (IVCD) diagnostic criteria, thepatients were divided into t-CLBBB group, traditional CLBBB group and IVCDgroup. The preoperative clinical data, Medication after operation、postoperativefollow-up ultrasound6months Beckoning cardiac structure index diagram(determination of left ventricular ejection fraction, left ventricular end diastolicdiameter), USA New York Heart Association (New York Heart Association, NYHA)classification of cardiac function changes,6minutes walk test were compared amongthe three groups, At last, the collected data were statistically analyzed by SPSS19.0. ResultsThe study included52patients (t-CLBBB group，20cases; traditional CLBBBgroup,15caes;IVCD group,17cases).Mean follow-up time was6months.1patientsuffered from pacemaker electrode fracture,1patient happened hospital infection, noelectrode dislocation, pacemaker syndrome, malignant arrhythmia, skin ulceration,death and so on among the follow-up period.At the6month follow-up, a meanabsolute increase in LVEF of（17.0%±11.2%）and a mean decrease in NYHA class of（-1.4%±0.7%）class was observed overall (P＜0.05). Among the three groups:Forpatients with t-CLBBB, mean change in LVEF was（17.0%±11.2%）, compared With(4.3%±6.8%)(P＜0.05) for those with traditional CLBBB, and (3.3%±5.8%)(P＜0.05) for those with IVCD. Mean reduction in LV end-diastolic dimension (LVEDD),was （-9.4%±7.8%）mm in the t-CLBBB,(-2.5%±4.6%) mm in the traditionalCLBBB (P＜0.05), and (-0.8±5.1) mm in the IVCD grouP (P＜0.05). New YorkHeart Association functional class also decreased significantly in patients witht-CLBBB（-1.4%±0.7%）, compared with (-0.8%±0.6%)(P=0.071) for those withtraditional CLBBB, and (-0.5±0.6)(P=0.01) for those with IVCD. Compared with(196.6±96.1) m for IVCD and (220.5±95.4) m for traditional CLBBB patients,Patients with t-CLBBB performed better in a6min walking test, walking（231.5±95.2）m (P=0.001).According to the clinical and cardiac structure indicators:In52patients, super-responders accounted for17.2%, respondents accounted for54.5%, non-responders accounted for28.3%. The baseline clinical data of all patientswith CRT were analyzed by multivariate Logistic regression analysis, the results：t-CLBBB odds ratios=12.35,95%confidence interval1.966～69.390,P=0.007;LVEDD，OR=0.891;95%confidence interval0.797～0.996;P=0.043;Female gender，OR=3.435；95%confidence interval，1.727～9.233；P=0.012.Thesedata show that t-CLBBB and CRT reactivity correlation.ConclusionCRT is an effective method in the treatment of chronic heart failure. CRT canreverse the left ventricular remodeling in patients with heart failure in a certain extent,significantly improve heart function, improve the quality of life; but not all heartfailure patients can benefit from CRT therapy. Among the numerous factors influencing CRT reactivity, t-CLBBB showed a greater correlation, may be aimportant predictor for CRT super-response.