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机构地区:[1]南京大学医学院附属鼓楼医院心内科,210008
出 处:《中华心律失常学杂志》2013年第3期188-191,共4页Chinese Journal of Cardiac Arrhythmias
摘 要:目的验证符合左束支阻滞(LBBB)新诊断标准的慢性心力衰竭患者是否能从心脏再同步治疗(CRT)中更显著地获益。方法人选2007年5月至2012年6月符合传统LBBB诊断标准且植入CRT患者,根据术前体表心电图形态分为“真性”LBBB组(真LBBB组:V1、V2导联负向波为主(QS或rS);V1、V2、V5、V6、I、aVL导联中至少有2个以上的导联QRS波中间有切迹或顿挫;QRS时限,男≥140ms、女≥130ms)和“假性”LBBB组(假LBBB组:符合传统的LBBB标准,但尚未达到“真性”LBBB诊断标准,具体包括上述6个导联中仅有1个或没有导联出现切迹或者顿挫,QRS时限,男〈140ms、女〈130ms)。术后定期随访,比较两组患者QRS时限、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)及心功能(NYHA分级)变化。结果共入选32例患者(男13例),真LBBB组23例,假LBBB组9例,术前两组患者间性别、年龄、基础疾病、IJVEF及心功能等基本情况差异无统计学意义。术后随访显示真LBBB组较假LBBB组LVEF增加显著(0.39±0.11对0.27±0.07,P=0.006),LVEDD缩小明显[(6.3±1.0)cm对(7.6±1.0)cm,P=0.003],提示真LBBB组对CRT治疗反应更佳。结论符合LBBB新诊断标准的慢性心力衰竭患者从CRT中更显著获益。Objective To evaluate if newly proposed criteria for left bundle branch block(LBBB)iden- tify patients of chronic congestive heart failure with a better clinical outcome from cardiac resynchronization therapy(CRT). Methods Between May 2007 and June 2012,patients met the traditional LBBB criteria and received CRT implantation were enrolled in this study. All patients were divided into" true" LBBB group and" false" LBBB group according to QRS morphology: "true"LBBB group definition: QS or rS in leads V1 and V2 ,mid-QRS notching or slurring in 2 of leads Vl, Vz, Vs, V6, I, and aVL, and QRS duration t〉 140 ms (M) or 130 ms (F) and "false" LBBB group definition:met the traditional criteria of LBBB, but did not meet the newly proposed criteria LBBB ,including mid-QRS notching or slurring in less than 2 of leads V1, V2, Vs, V6 ,l,or QRS duration ≤ 140 ms ( M ) or 130 ms (F). During follow-up, QRS duration,left ventricular end diastolic diameter( LVEDD ), left ventricular ejction fractions(LVEF) and NYHA class were examined and recorded. Results Tweenty-three patients accorded with "true" LBBB and 9 patients accorded with "false" LBBB.The base-line clinical characteristics were similar in two groups. At the end of follow-up, reverse remodeling was achieved better in "true" LBBB group than that in "false"LBBB group.There were significant reduction of LVEDD[ (6. 3±1.0) cm vs (7. 6±1.0) cm,P= 0. 003] and increased of LVEF (0. 39±0. 11 vs 0. 27±0. 07,P=0. 006) in "true"LBBB group. Conclusion Patients of chronic congestive heart failure accorded with new LBBB criteria had a better clinic outcome with CRT.
分 类 号:R541[医药卫生—心血管疾病]
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