Abstract:

Objective　To analyze the factors influencing non-response to cardiac resynchronization therapy (CRT) in elderly patients with heart failure. Methods　A retrospective analysis was conducted on the clinical data of 80 elderly heart failure patients who underwent CRT between May 2020 and May 2023 at the Department of Cardiology, Xi'an Central Hospital, including 46 males and 34 females, 50 cases ≥80 years old and 30 cases <80 years old, cardiac function grade: 53 cases of grade III and 27 cases of grade IV. The patients were observed for CRT response and were categorized into the response and non-response groups. The clinical data were analyzed using univariate analysis, and variables with statistically significant differences were further analyzed using multivariate logistic regression analysis to analyze the influencing factors of non-response after CRT in elderly patients with heart failure. Independent sample t test and χ² test were used. Results　Among the 80 elderly patients who underwent CRT, 59 responded to the treatment, and 21 did not, resulting in a response rate of 73.75%. There were no statistically significant differences in the age, gender, body mass index, smoking history, drinking history, diabetes history, hypertension history, left atrial inner diameter (LAD), right ventricular inner diameter (RVD), triglyceride (TG) level, and cardiac function grade between the two groups (all P>0.05). There were statistically significant differences in the course of disease, mitral regurgitation volume, QRS wave duration, left ventricular ejection fraction (LVEF), and total cholesterol (TC) between the two groups (all P<0.05). Multivariate logistic regression analysis showed that the duration of disease ≥3 years, increased mitral regurgitation volume, reduced QRS wave duration, LVEF ≤30%, and elevated TC level were all risk factors for non-response to CRT in elderly patients with heart failure (all P<0.05). Conclusion　For elderly heart failure patients, risk assessment, electrophysiological evaluation, enhanced cardiac support, lipid management, and lifestyle interventions are essential to enhance the efficacy of CRT, reduce the non-response rate, and ultimately improve the patients' prognosis and quality of life.

Key words:

Heart failure, Elderly, Cardiac resynchronization therapy, Response, Influencing factors

摘要：

目的　分析影响老年心力衰竭患者心脏再同步化治疗（CRT）后无应答的相关因素。方法　回顾性分析2020年5月至2023年5月期间西安市中心医院心内科收治的80例行CRT的老年心力衰竭患者的临床资料，其中男46例、女34例，年龄≥80岁50例、<80岁30例，心功能分级Ⅲ级53例、Ⅳ级27例。观察CRT应答情况，分为应答组和无应答组，对两组患者的临床资料进行单因素分析，并将差异有统计学意义的变量纳入多因素logistic回归分析，分析老年心力衰竭患者CRT后无应答的影响因素。采用独立样本t检验、χ²检验。结果　在80例行CRT的老年心力衰竭患者中，治疗3个月后，应答患者59例，无应答患者21例，应答率73.75%。两组患者在年龄、性别、体质量指数、吸烟史、饮酒史、糖尿病史、高血压病史、左心房内径（LAD）、右心室内径（RVD）、三酰甘油（TG）水平及心功能分级等方面比较差异均无统计学意义（均P>0.05）；两组患者在病程、二尖瓣反流量、QRS波时限、左心室射血分数（LVEF）、总胆固醇（TC）等方面差异均有统计学意义（均P<0.05）。多因素logistic回归分析显示，病程≥3年、二尖瓣反流量的增加、QRS波时限的降低、LVEF≤30%、TC值的升高均为老年心力衰竭患者CRT无应答的危险因素（均P<0.05）。结论　对于老年心力衰竭患者，应进行深入的风险评估和电生理评估，同时加强心功能支持并接受血脂管理和生活方式的干预，有助于提升CRT的有效性，降无应答率，最终改善患者的预后和生活质量。

关键词:

心力衰竭, 老年, 心脏再同步化治疗, 应答反应, 影响因素