左心室收缩不同步在非缺血性扩张型心肌病患者的预后价值  

Prognostic significance of left ventricular systolic dyssynchrony in patients with nonischemic dilated cardiomyopathy

作　　者：刘忠芬[1] 刘怡红 杜宗雷[2] 王玉其[2] 孙晓斐[3] 

机构地区：[1]章丘市人民医院急症科,山东章丘250200 [2]邹城市人民医院心内科,山东邹城273500 [3]济宁市第一人民医院心脏中心,山东济宁272000

出　　处：《心脏杂志》2013年第2期204-207,共4页Chinese Heart Journal

摘　　要：目的:运用组织多普勒超声心动图研究左心室收缩不同步在非缺血性扩张型心肌病患者中的预后价值。方法:入选62例非缺血性扩张型心肌病患者,所有患者均行心电图、超声心动图(包括组织多普勒超声心动图)及冠状动脉造影,入选患者根据心室内延迟时间(IVD)分为2组:IVD≤65 ms组(n=10)和IVD>65 ms组(n=52),主要终点定义为随访期内的全因死亡。结果:IVD>65 ms组患者有较长的心室内延迟时间[(129±68)ms vs.(58±9)ms;P<0.05],较高的左束支传导阻滞发生率(31%vs.10%;P=0.05),更长的QRS间期[(145±29)ms vs.(129±23)ms,P<0.05]较高的病死率(56%vs.10%;P<0.01).IVD≤65 ms组中1例患者发生心源性猝死;而IVD>65 ms组中有12例发生,且其他原因引起的死亡也发生在组IVD>65 ms组。Kaplan-Meier生存分析显示IVD>65 ms组患者有较低的生存率(P<0.05),多因素分析显示IVD是唯一具有显著差异的死亡预测因子(P<0.01)。结论:高IVD是非缺血性扩张型心肌病患者死亡的独立预测因素。AIM： To investigate the prognostic significance of left ventricular （LV） systolic dyssynchrony in nonischemic dilated cardiomyopathy （DCM） using tissue Doppler echocardiography （TDI）. METHODS ： The study was conducted in 62 patients with nonischemic DCM. All patients were examined by electrocar- diography TDI and angiography. Patients were allocated into two groups： group 1 - 10 patients with intra- ventricular delay （IVD） ≤65 msec and group 2 -52 patients with IVD 〉 65 msec. The primary endpoint was defined as overall mortality during a mean follow-up period. RESULTS： Patients in group 2 had sig- nificantly longer mean IVD [ （129 ± 68 ） msec vs. （58 ±9） msec; P 〈 0. 05 ], higher rate of left bundle branch block （31% vs. 10% ; P =0.05）, longer QRS duration [（145 ±29） msec vs. （129 ±23） msec; P 〈0. 05] and higher fatality rate （56% vs. 10% ; P 〈0. 01）. Sudden cardiac death occurred in one patient in group 1 but in 12 patients in group 2. All the remaining deaths （ n = 17） occurred in group 2. Kaplan-Meier survival analysis showed a significantly lower survival in group 2 （ P 〈 0. 05 ） and multi- variate analysis showed that IVD was the only significant independent predictor of mortality （P 〈 0. 01 ）. CONCLUSION： Increased IVD is associated with increased risk for death in patients with nonischemic DCM, independent of the QRS width and LV ejection fraction.

关 键 词：心肌病 扩张型 非缺血性 左心室收缩不同步 超声心动图 心电描记术 预后 

分 类 号：R542.2[医药卫生—心血管疾病]