真性及非真性左束支传导阻滞心力衰竭患者心脏再同步治疗预后分析  被引量:5

Analysis of prognosis of cardiac resynchronization therapy for patients with chronic heart failure with true or non-true complete left bundle branch block

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作  者:李阳[1] 张琳[1] 李健[1] 侯志文[1] 于波[1] 

机构地区:[1]中国医科大学附属第一医院心内科,辽宁沈阳110001

出  处:《中国实用内科杂志》2017年第4期334-338,共5页Chinese Journal of Practical Internal Medicine

基  金:辽宁省科技公关课题(201225084)

摘  要:目的回顾性分析真性左束支传导阻滞、非真性左束支传导阻滞的慢性心力衰竭患者接受心脏再同步化治疗(CRT)的预后情况。方法选取2005年12月至2015年12月于中国医科大学附属第一医院成功植入CRT-P/D的慢性心力衰竭患者47例。根据术前体表心电图表现分为真性左束支传导阻滞组(t-LBBB,25例),非真性左束支传导阻滞组(nt-LBBB,22例),分析比较各组患者预后情况。结果t-LBBB组左室射血分数较nt-LBBB组增加[△LVEF:t-LBBB对nt-LBBB(17.12±6.80)%对(11.29±9.91)%,P=0.039];t-LBBB组左室舒末内径及左室收缩末容积较nt-LBBB组显著改善[△LVEDD:t-LBBB对nt-LBBB:(-9.88±6.55)mm对(-5.77±6.57)mm,P=0.041;△LVESV:t-LBBB对nt-LBBB:(-54.56±37.14)mL对(-25.59±46.81)mL,P=0.025]。多变量回归分析示真性左束支传导阻滞是CRT术后有反应的独立预测因子。结论QRS波形符合真性左束支传导阻滞标准的患者更能从CRT治疗中获益。Objective To analyze retrospectively the clinical response and prognosis of cardiac resynchronization therapy (CRT) for patients with chronic heart failure (CHF) with true complete left bundle branch block or non-true complete left bundle branch block. Methods TolaUy 47 patients were collected with implantation of CRT-P/D in the First hospital of China Medical University from Dec. 2005 to Dec. 2015. The 47patients were divided into 2 groups: true-complete hft bundle branch block (t-LBBB) group, (n=25), non-true left bundle block (nt-LBBB) group, (n=22). The difference in clinical materials and outcomes was analyzed in 2 groups. Results The mean absolute increases in LVEF in t-LBBB group were more significant than those in nt-LBBB group [△LVEF: t-LBBB vs. nt-LBBB:(17.12±6.80)% vs.(11.29±9.91)% P=0.039]; the mean absolute reduction in LVEDD and LVESV in t-LBBB group was also more significant than that in nt-LBBB group[△LVEDD: t-LBBB vs nt-LBBB: (-9.88±6.55)mm vs (-5.77±6.57)mm, P=0.041], [LVESV: t-LBBB vs nt-LBBB (-54.56±37.14)mL vs (-25.59±46.81) mL, P=0.025]. Multivariate analysis showed that t-LBBB was independent predictors of response to CRT. The non-LBBB group showed the worst clinical response and prognosis. Conclusion The patients with the t-LBBB morphology are related to a better response to CRT.

关 键 词:心脏再同步化治疗 慢性心力衰竭 真性左束支传导阻滞 

分 类 号:R541.7[医药卫生—心血管疾病]

 

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