我的课件华伟crt进展2012

1、 Men (n = 237) Women (n = 230) 1 Framingham Heart Study (1948 1988) in Atlas of Heart Diseases. 2 American Heart Association. Heart Disease and Stroke Statistics2003 Update. 3.New England Journal of Medicine 2002 80% 男性男性 70% 女性会在女性会在8 年内死亡年内死亡2 有症状的进展性心衰 患者一年的死亡率 可以高达45%3 导致心衰病理生理链的危险因素导致心衰病理生理链的危险

2、因素 Dzau and Braunwald. Am Heart Journal 1991 危险因子危险因子 (血脂血脂,血压血压,糖尿病等糖尿病等.) 粥样硬化粥样硬化 左室肥大左室肥大 冠心病冠心病 心肌缺血心肌缺血 冠状动脉栓塞冠状动脉栓塞 心肌梗死心肌梗死 心律失常心律失常 26Pt. II: 137143 LVEF/LVFS降低 LVEDD增加 ESV增加 左室重构 左房直径增加 引起二尖瓣反流 右室起搏右室起搏 房室结房室结 窦房结窦房结 右室心尖部起搏导致心脏失同步 右室起搏的风险 导致电学失同步 （三）轻度心衰患者再同步治疗 REVERSE试验 Lind C et al.J Am

3、 Coll Cardiol. 2008;52(23):1834-43. REVERSE 研究 Lind C et al.J Am Coll Cardiol. 2008;52(23):1834-43. Tang AS, Wells GA, Talajic M, et al.Cardiac-resynchronization therapy for mild-to-moderate heart failure. Engl J Med. 2010 Dec 16;363(25):2385-95 基线评估 随机 1:1 双盲 ICD Only (N = 904) CRT-D (N = 894) 平均随访

4、平均随访40个月个月 25% reduction with CRT Death or HF Hospitalization: 27% Risk Reduction with CRT-D P=0.001 0% 20% 40% 60% 80% 100% 0123456 Years of Follow-up Event-free Survival Death: 29% Risk Reduction with CRT-D P=0.006 0% 20% 40% 60% 80% 100% 0123456 Years of Follow-up Event-free Survival CRT-D ICD HR

5、 (95% CI): 0.73 (0.61, 0.88) CRT-D ICD HR (95% CI): 0.71 (0.56, 0.91) No. at Risk CRT-D ICD 708 730 640 638 488 465 315 299 181 146 70 57 15 6 No. at Risk CRT-D ICD 708 730 679 687 530 533 361 366 206 189 89 83 20 13 Tang AS, et al. N Engl J Med. 2010;363: 2385-95 Cardiac-Resynchronization Therapy f

6、or the Preventionof Heart-Failure Events（MADIT-CRT) （心脏再同步化治疗预防心衰事件）（心脏再同步化治疗预防心衰事件）2009，10 October 1, 2009 vol. 361 no. 14 N=1820 p0.001 ICD CRT-D 1.0 0.9 0.8 0.7 0.6 0.0 Heart Failure Free Survival Probability 01234 Years from Randomization Patients at risk CRT-D ICD-only Kaplan-Meier Estimate of

7、Heart Failure Free Survival Probability Curves diverge within the 2 first months CRT-D = CRT with defibrillator function; HF = heart failure; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association; SR sinus rhythm. HFSA CRT Guideline Update Indications for Cardiac Resynchroniza

8、tion Therapy: 2011 Update From the Heart Failure Society of America (HFSA) Guideline Committee Journal of Cardiac Failure Vol. 18 No. 2 ,2012 HFSA CRT Guideline Update 32# Sudden death Sudden death Sudden death Class II=103Class III=232Class IV=27 Data from MERIT trial 心室颤动心室颤动 电击电击 规则心律规则心律 Implant

9、able Cardioverter Defibrillator (probability of survival) 0.78 0.690.69 (probability of survival) P=0.007 Kaplan-Meier Survival by Treatment Group SCD-HeFT 2003年美国年美国ICD植入量超过植入量超过12万台万台 2005年植入量达到年植入量达到18万台万台 2007年心脏植入性电子设备应用情况年心脏植入性电子设备应用情况 Heart Rhythm, June 2008 CRT年植入量（2010/2011） CRT-D所占比例(2010/

10、2011) 1 Assumes a 0.4 ms pulse width, DDD mode, 100% biventricular pacing and 50% atrial pacing at 60 min-1 with the remainder at 70 min-1 atrial tracking (amplitudes of 2.5 V for the A/RV and 3.0 V for the LV, at 700 ohms), and semiannual full-energy charges. 2 Assumes fully-formed capacitors, Charge to full output, first time is BOL, second time is ERI 主要特性 心衰恶化肺部充血 胸腔内阻抗 下降 阻抗下降阻抗下降 肺部水肿肺部水肿 一旦液体在肺内积聚，胸腔内阻抗下降一旦液体在肺内积聚，胸腔内阻抗下降 4.7 Fr Isodiametric Lead Body 4Fr Steroid Eluting Lead Tip Optim Isolation Lenght 75cm, 86cm und 92cm New