单中心左室射血分数小于等于0.35患者宽QRS波时限比例调查及相关因素分析  

Single center based study on ratio of wide QRS duration in cohort of patients with left ventricular ejection fraction≤0.35

作　　者：陈卫文[1] 林靖宇[1] 刘军[1] 宿燕岗[1] 

机构地区：[1]复旦大学附属中山医院心电图室,上海200032

出　　处：《中国心脏起搏与心电生理杂志》2015年第6期529-532,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的了解国内心力衰竭（简称心衰）患者具有心脏再同步化治疗（CRT）适应证的比例，为进一步有的放矢的更好开展CRT工作提供相关的临床依据。方法连续入选本院门诊或病房就诊的超声心动图测量左室射血分数（LVEF）≤0．35患者，收集其临床资料并同时行12导联心电图检查，测得QRS波群时限，并将心电图表现与患者临床资料进行对比分析。结果①共入选451例，以扩张型心肌病最常见，占80．3％。②QRS波时限≥120ms147例（占32．6％），其中，QRS波时限≥120ms心电图表现类型为左束支阻滞84例（18．6％），心室内阻滞44例（9．8％），右束支阻滞19例（4．2％）。③年龄段〈30岁、30～39岁、70—79岁、≥80岁QRS波时限与性别无差异，而40～49岁、50～59岁及60～69岁年龄段，女性宽QRS波的比例高于男性。④将QRS波时限分为〈120ms、120～135ms和≥135ms三组，显示QRS波时限与左室舒张末内径（LVEDD）存在正相关。⑤QRS波时限与NYHA心功能分级显著相关，QRS波时限越宽，心功能越差。⑥QRS波时限与LVEF值（分为〈0．20，0．20～0．30及≥0．30）呈负相关（r=-0．1402，P=0．0028）。结论国内心衰患者存在CRT适应证者的比例并不低，QRS波时限与左室内径、心功能及LVEF值显著相关。Objective To investigate the electrocardiographic characteristics of patients with severe left ventricular systolic dysfunction （LVSD）, and provide evidence for appropriate selection of patients for cardiac resynchronization therapy （CRT）. Methods Out-patients and in-patients with severe LVSD defined as left ventricular ejection fraction （LVEF） ≤0.35 came from Department of Cardiology,Zhongshan Hospital were consecutively recruited from March to July, 2014. Clinical and 12-lead electrocardiographic data were collected and analyzed. Results A total of 451 patients were eligible for analysis. Dilated cardiomyopathy was the most common underlying disease as diagnosed in 362 patients （80.3%）. 147 patients had QRS duration~〉120 ms （32.6%）, among whom 84 had left bundle branch block （18.63%）, 44 had intraventricular block （9.76%）, and 19 had right bundle branch block （4.21%）. In patients of 40 to 69 years old, QRS duration was significantly wider in women than in men （P〈0.05）, while there was no significant correlations between QRS duration and sex in other age groups. QRS was significantly correlated with left ventricular end dilated diameter （P = 0. 035）, New York Heart Association class （P=0. 014）, and LVEF （r=-0. 140, P=0.015）. Conclusion A relatively large proportion of patients with severe LVSD are eligible for CRT, and much effort should be guaranteed to assure them receiving the appropriate therapy. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2015,29 （ 6 ） ： 529-532 ]

关 键 词：心血管病学 左室射血分数 宽QRS波时限 调查 

分 类 号：R540.41[医药卫生—心血管疾病]