QRS时限和形态对心脏再同步治疗效果的影响  

Impact of QRS duration and morphology on response to cardiac resynchronization therapy

作　　者：刘志泉[1] 陈康玉[1] 严激[1] 徐健[1] 苏浩[1] 杨冬妹 陈娟 胡凯[1] 章超惠 王齐[1] 谢翠平[1] 

机构地区：[1]安徽医科大学附属省立医院心内科,安徽省心血管病研究所,合肥230001 [2]安徽医科大学附属省立医院超声心动图室

出　　处：《临床心血管病杂志》2015年第10期1086-1090,共5页Journal of Clinical Cardiology

基　　金：2013年安徽省科技攻关计划项目(No:1301042210);2010年安徽省卫生厅医学科研重点项目(No:2010A002)

摘　　要：目的：探讨心电图QRS时限和形态对心脏再同步治疗（CRT）效果的影响。方法：入选植入CRT/D装置的患者272例,依据术前心电图QRS时限将其分为轻度延长（120-149ms）组、中度延长（150-179ms）组和重度延长（≥180ms）组,比较3组患者CRT反应情况;依据左束支阻滞（LBBB）诊断新标准,将患者分为真性LBBB组和假性LBBB组,比较两组患者CRT反应情况。结果：QRS时限中度（62.8%）、重度（54.3%）延长组CRT反应率优于轻度（49.6%）延长组;真性LBBB组CRT反应率优于假性LBBB组（64.3%︰52.9%）。多因素分析显示宽QRS波和真性LBBB与CRT反应率增加有关。结论：QRS时限中、重度延长组患者CRT反应率优于轻度延长组,而中度和重度延长组患者间CRT反应率无明显差别;真性LBBB组CRT反应率优于假性LBBB组。Objective：To evaluate the impact of QRS duration and morphology on response to cardiac resynchronization therapy（CRT）.Method：A total of 272 patients received CRT/D implantation were enrolled.All patients were divided into mild prolonged（QRSd：120-149ms）,moderate prolonged（QRSd：150-179ms）,and severe prolonged（QRSd：≥180ms）group according to QRS duration.Furthermore,patients were divided into true LBBB and false LBBB group according to QRS morphology.A comparison was made according to different QRS duration and morphology.Result：Moderate and severe prolonged group（QRSd≥150ms）achieved better reverse remodeling and CRT response（62.8% or 54.3% vs.49.6%）,but there was no significant difference between moderate and severe prolonged group（59.3% vs.60%）.Moreover,compared with false LBBB group,true LBBB group had superior CRT response（64.3% vs.52.9%）.In multivariable analyses,QRSd≥150ms and true LBBB were emerged as powerful predictor of CRT response.Conclusion：CRT response is better in patients with preimplant QRSd of≥150ms and or true LBBB but worse in patients with a QRSd of 120-149ms and or false LBBB.

关 键 词：QRS时限 左束支阻滞 心脏再同步治疗 

分 类 号：R541.7[医药卫生—心血管疾病]