完全性右束支传导阻滞在评价急性心力衰竭患者预后中的价值  

Predicting long-term mortality in acute heart failure in patients with complete right bundle branch block

作　　者：王慧敏[1] 吴倩芸[1] 王凯[1] 徐雪娟[1] 张丽[1] 周芳[1] 李新立[1] WANG Huimin WU Qianyun WANG Kai XU Xuejuan ZHANG Li ZHOU Fang LI Xinli(Department of Cardiology, the First Affiliated Hospital with Nanjing Medical University,Nan jing, 210029, China)

机构地区：[1]南京医科大学第一附属医院心脏科,南京210029

出　　处：《临床心血管病杂志》2017年第9期836-840,共5页Journal of Clinical Cardiology

基　　金：国家科技支撑计划课题(No:2011BAI11B08);江苏省六大人才高峰资助项目[No:WSN-031(IB15)]

摘　　要：目的:探讨完全性右束支传导阻滞(CRBBB)与急性心力衰竭(AHF)患者长期病死率之间的相关性。方法:入选2012-03-2015-02因AHF入住我院的患者346例,收集与分析入选者的临床资料及入院时的相关检验及检查结果,前瞻性随访所有患者18个月,其终点事件为全因死亡。根据终点事件将其分为死亡组和生存组。结果:(1)39例(11.3%)失访,73例(23.8%)死亡;(2)完成随访的307例AHF患者中有35例(11.4%)合并CRBBB,其中生存组中有17例,而死亡组中18例(P<0.01);(3)Kaplan-Meier分析后发现合并CRBBB的AHF患者死亡风险明显高于无CRBBB的AHF患者(P<0.01);(4)CRBBB用于预测AHF患者预后的特异度可达92.7%(95%CI88.6~95.7),敏感度为24.7%(95%CI 15.3~36.1);(5)COX逐步回归分析(向前)显示,合并CRBBB的AHF患者比无CRBBB的AHF患者死亡风险超过2倍(HR=3.912,95%CI 2.208~6.933)。结论:CRBBB对评估AHF患者长期预后有重要价值。Objective：To investigate the relationship between the complete right bundle branch block（CRBBB）patterns and long-term mortality of heart failure（AHF）in Chinese patients.Method：We enrolled 346 patients who had been hospitalized for AHF in cardiovascular department of the First Affiliated Hospital of Nanjing Medical University,from March 2012 to February 2015.The Primary endpoint was all-cause mortality during 18-months follow up.Result：（1）Thirty-nine participants（11.3%）dropped out,73patients（23.8%）dead at the end of this study.（2）Among the 307 patients,CRBBB was present in 35patients（11.4%）,including 18 patients in the death group and 17 patients in the survivor group,which was statistically significant（P〈0.01）.（3）Kaplan-Meier analysis revealed that patients with CRBBB were at higher risk of death when compared with patients without CRBBB（P〈0.01）.（4）The calculation shows that the specificity of CRBBB for predicting the prognosis of patients with AHF was up to 92.7%（95%CI 88.6~95.7）,and the sensitivity was 24.7%（95%CI 15.3~36.1）.（5）In COX stepwise regression analysis（forward）,after multivariable adjustment,CRBBB was associated with over two-fold increase in mortality[hazard ratio（HR）=3.912,95%CI2.208~6.933].Conclusion：CRBBB seems to be a promising predictor of long-term mortality in AHF with Chinese patients.

关 键 词：急性心力衰竭 完全性右束支传导阻滞 预后 

分 类 号：R541.6[医药卫生—心血管疾病]