中文摘要：

目的探讨非缺血性心肌病患者舒张充盈模式对心脏再同步治疗（CRT）疗效的影响。方法将2012年1月至2013年9月于安徽省立医院接受CRT的100例非缺血性心肌病患者，根据术前舒张充盈模式，分为松弛功能异常组、假性正常化组和限制性充盈组。随访12个月，根据美国纽约心脏病协会（NYHA）心功能分级，超声心动图检查评估各组CRT疗效。以心衰再人院或心源性死亡为终点事件，绘制生存曲线，评估各组预后。结果纳入研究的100例患者，均存在不同程度的舒张功能异常，其中松弛功能异常组61例，假性正常化组18例，限制性充盈组21例，多因素Logistic回归分析显示舒张充盈模式是CRT反应性的独立影响因素。（1）松弛功能异常组：CRT反应率（78．7％）显著高于其他2组（P〈0．01）；术后NYHA分级，左心室射血分数（LVEF），短轴缩短率（Fs），左心室舒张末期容积（LVEDV）及左心室收缩末期容积（LVESV）均显著改善（P〈0．01）。（2）假性正常化组：术后3个月NYHA分级由（3．3±0．5）级显著改善为（2．3±0．5）级（P〈0．01）；LVEF由（27±7）％增加到（31±6）％（P〈0．01）；FS增加（P〈0．05）；LVEDV及LVESV均无显著变化。术后6个月LVEF显著增加（P〈0．05）；LVESV较前降低（P〈0．05）。（3）限制性充盈组：仅出现术后3个月的NYHA分级改善（P〈0．01）；术后6个月NYHA分级，LVEF，FS及LVESV较前呈恶化趋势，LVEDV较前增加（P〈0．05）。术后6个月三组间的疗效差异有统计学意义（P〈0．01）。至随访结束，5例患者死亡，限制性充盈组累积终点事件发生率81％，显著高于其他2组（P〈0．05）。结论在符合CRT指征的中重度收缩性心衰患者中，异常的舒张功能影响CRT疗效，合并松弛功能异常的非缺血性心肌病患者CRT获益明显，合并假性正常化的患者CRT获益需要更长的

英文摘要：

Objective To investigate the influence of diastolic filling pattern on the efficacy of cardiac resynchronization therapy （CRT） in patients with non-ischemic cardiomyopathy. Methods Between January 2012 and September 2013, 100 patients with non-ischemic cardiomyopathy undergoing CRT were enrolled in the study, and all patients were grouped by the pre-CRT diastolic filling pattern as impaired relaxation, pseudonormalized and restrictive filling. After follow up for 12 months, the New York Heart Association （NYHA） Class and echocardiography were used to assess the efficacy of CRT. The endpoint was rehospitalization for heart failure or cardiac death. Kaplan-Meier survival curves were plotted to assess prognosis. Results All patients had varying degrees of diastolic dysfunction. Logistic regression analysis indicated that diastolic filling pattern was the independent factor for the response of CRT. （1）The response rate （78. 7% ） of impaired relaxation group （n = 61 ） was significantly higher than that of the other two groups （ P 〈 0. 01 ） ; postoperative NYHA class, left ventricular ejection fraction （ LVEF ）, fraction shortening （FS）, left ventricular end-systolic volume （LVESV） and left ventricular end-diastolic volume （LVEDV） were significantly improved （ all P 〈 0. 01 ）. （ 2 ） For pseudonormalized group （ n = 18 ）, at the 3^rd month, NYHA class decreased from 3.3 ±0. 5 to 2. 3 ±0. 5, LVEF increased from 27% ±7% to 31% ± 6% （ both P 〈 0. 01 ）, and FS improved significantly （ P 〈 0. 05 ） ; no significant decrease of LVEDV and LVESV was found. At the 6^th month, LVEF improved significantly （ P 〈 0. 01 ） ; LVESV was reduced （P 〈 0. 05）. （3）In restrictive filling group （n = 21 ）, CRT brought short-term improvement in NYHA class but did not induce any significant improvement in LVEF, FS, LVESV and LVEDV. At the 6^th month, there were significant differences in efficacy among the three groups （ P 〈 0. 05 ）. At the end of fo