Relevant Factors Of Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy

ObjectiveHeart failure is the final stage of most cardiac diseases.Without timely intervention,the prognosis is very poor.Cardiac resynchronization therapy is a revolutionary breakthrough in the field of heart failure treatment.It is an important treatment for heart failure to increase left ventricular pacing on the basis of traditional right atrium and right ventricular biventricular pacing to restore the synchronization of atrioventricular,interventricular and intraventricular motions,improve ejection fraction and improve cardiac remodeling.However,nearly 30%of patients showed no response to CRT.The purpose of this study was to find out the factors related to left ventricular reverse remodeling after CRT by analyzing the data of CRT patients,and further improve CRT responsiveness.MethodsThis study retrospectively analyzed 87 patients with chronic heart failure who received CRT-P/D implantation in the interventional center of Cardiovascular Medicine,Second Affiliated Hospital of Medical College of Zhejiang University from December 2014 to September 2018.All patients met the CRT implantation criteria in the guidelines for heart failure.All patients were followed up for 6 months after operation.Left ventricular reverse remodeling criteria:Six months after operation,echocardiography showed that LVEF increased by more than 10%or LVEDD decreased by more than 10%.ResultsA total of 87 patients with heart failure were enrolled in this study.The study population consisted of 45(51.7%)males,with an average age of 63.05±11.36,BMI of 23.51±3.66 kg/m2,ischemic cardiomyopathy of 5(5.7%),hypertension of 45(51.7%),diabetes of 18(20.7%),atrial fibrillation of 18(20.7%),renal insufficiency of 13(15.0%)and preoperative serum albumin of 37.53±3.95 g/l,LDL-C of 2.30±0.69mmol/l.The mean value of uric acid was 429.66±141.18 umol/1,NYHA grade IV was 28(32.2%).The mean value of preoperative echocardiographic LAD was 43.96±6.07 mm,the mean value of LVEDD was 67.24±8.64 mm,the average value of LVESD was 58.28±9.00 mm,and the average value of LVEF was 29.18±7.29%.In 52(59.8%)cases,LVEF increased by more than 10%,LVEDD decreased by more than 10%in 40(46.0%)cases,and left ventricular reverse remodeling occurred in 58(66.7%)cases.There were no differences in gender,age,height,weight and other general data between patients with and without reverse remodeling.The results showed that although BMI was higher in patients with reverse remodeling,there was no significant difference(P>0.05).Similarly,there was no difference between the patients with or without reverse remodeling in primary heart disease,hypertension,diabetes,atrial fibrillation and renal insufficiency.There was no difference in albumin,LDL-C,uric acid and other blood test indicators between patients with and without reverse remodeling.There was no difference in NYHA grade and QRS time before implantation in patients with or without reverse remodeling;there was difference in QRS morphology(P<0.01);the proportion of LBBB in patients with reverse remodeling was higher than that in patients without reverse remodeling;there was difference in NYHA grade after implantation(P<0.01);the proportion of NYHA grade ? in patients with reverse remodeling was higher than that in patients without reverse remodeling.Before implantation,there was no difference in LAD,LVEDD,LVESD,and LVEF between patients with and without reverse remodeling.There were no differences in the types of beta-blockers,aldosterone antagonists,ACEI/ARB,diuretics,digitalis and other heart failure drugs and leads in the cases of reverse remodeling.Logistic regression showed that LBBB was an independent risk factor for reverse remodeling after CRT.ConclusionsReverse remodeling of left ventricle and improvement of cardiac function are significant after CRT.LBBB is an independent risk factor for left ventricular reverse remodeling after CRT.