冠状动脉慢性完全闭塞病变患者碎裂QRS波与血运重建术后左心室心功能改善的研究  

Relationship between left ventricular function recovery after coronary revascularization and fragmented QRS complex in patients with chronic total occlusion

作　　者：汤振 刘志忠[2] 刘发军[3] 胡作英[2] 朱琳琳[2] 张娟[2] 单守杰 

机构地区：[1]宿迁市第一人民医院心内科,江苏宿迁223800 [2]南京医科大学附属南京医院心内科,江苏南京 [3]六安市第二人民医院心内科,安徽六安

出　　处：《中国介入心脏病学杂志》2016年第7期385-389,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的观察冠状动脉慢性完全闭塞病变(CTO)患者经皮冠状动脉介入治疗(PCI)术后左心室功能恢复情况与碎裂QRS波的关系。方法回顾性分析2010年1月至2014年10月成功行PCI的260例单支主要冠状动脉CTO患者,按照入院时12导联体表心电图QRS波形态分为碎裂QRS波组(f QRS组,76例)和无碎裂QRS波组(nf QRS组,184例),应用实时三维超声心电图(RT-3DE)评价左心室局部室壁运动情况,随访两组患者PCI术后6个月左心室局部室壁运动和心功能改善情况。结果两组患者PCI术后左心室射血分数(LVEF)、室壁运动计分(WMSI)、NYHA心功能分级均有所改善,但与术前相比,nf QRS波组患者术后LVEF[(42.1±3.51)%比(53.26±4.47)%,P=0.03]增加、WMSI[(1.61±0.34)比(1.25±0.27),P=0.04]减少、NYHA心功能分级亦有显著改善(P=0.04),差异均有统计学意义;而f QRS组术前、术后差异无统计学意义(P>0.05)。结论 PCI术能够改善CTO患者的心脏功能,nf QRS波患者术后心功能改善显著,分析体表心电图f QRS波可预测术后左心室局部室壁运动的恢复。Objective To explore the relationship between left ventricular function recovery after percutaneous coronary intervention （PCI） and fragmented QRS （fQRS） complex in patients with chronic total occlusion.Methods Patients （n =260） with single CTO lesions underwent successful intervention from January 2010 to October 2014 were included and divided into fQRS group （n =76） and non-fQRS group （n =184） based on the QRS complex morphology on ECG before PCI.Left ventricular regional wall motion was evaluated by real-time three-dimensional echocardiography （RT-3DE） at baseline and during followup.The differences in the changes of cardiac function and left ventricular regional wall motion 6 months after PCI were analyzed between the two groups.Results At 6 months after PCI,increase in left ventricular ejection fraction （LVEF） with decrease in wall motion score index （WMSI） and improvement in patients＇ NYHA classification were observed in both groups.Compared with pre-PCI situation,non-fQRS group had more significant increase in LVEF [（42.1 ± 3.51）％ vs.（53.26 ± 4.47）％,P =0.03],decrease in WMSI [（1.61 ± 0.34） vs.（1.25 ± 0.27）,P =0.04] and more significant improvement in NYHA classinfication after PCI.No significance differences in LVEF,WMSI and NYHA classification in patients in the fQRS group were found before and after PCI （P ＞ 0.05）.Conclusions PCI can improve the cardiac function in the patients with CTO,and the improvement of left ventricular function is more obvious in patients without fQRS after PCI.fQRS complex can predict the recovery of regional wall motion in patients with successful CTO recanalization.

关 键 词：经皮冠状动脉介入治疗 超声心动图 慢性完全闭塞病变 局部室壁运动 

分 类 号：R541.4[医药卫生—心血管疾病]