R-V_1振幅对完全性左束支传导阻滞患者心脏再同步化治疗反应性的影响  

Effect of R-V_1 amplitude on CRT reactivity in patients with complete left bundle branch block: a retrospective study of 108 cases

作　　者：廖品亮[1] 舒茂琴[1] 庄国强[1] 柴虹[1] 邓盛荣[1] 宋治远[1] 

机构地区：[1]第三军医大学西南医院心血管内科,重庆市介入心脏病学研究所,重庆400038

出　　处：《第三军医大学学报》2017年第21期2120-2125,共6页Journal of Third Military Medical University

摘　　要：目的探讨V_1导联起始r波振幅(R-V_1)对真性左束支传导阻滞(t-CLBBB)患者心脏再同步化治疗(cardiac resynchronization therapy,CRT)反应性的影响。方法从2012年10月至2016年12月在我院接受CRT的108例患者中,遴选出术前心电图为t-CLBBB且资料完整的患者共55例,根据R-V_1振幅分为研究组(R-V_1≥0.1 m V,n=26)和对照组(R-V_1<0.1 m V,n=29)进行回顾性分析。由专人随访并记录心电图与超声心动图,评估CRT患者心功能应用纽约心脏病学会(New York Heart Association,NYHA)分级变化,测量QRS时限,检测各心腔舒张末期内径(左心室、右心室、左心房、右心房)、左心室射血分数(LVEF)、短轴缩短率(FS)等,评估两组患者的CRT反应性及临床获益情况。患者均完成至少6个月随访。结果 CRT前两组间各项资料差异无统计学意义(P>0.05)。CRT后两组患者QRS波时限、LVEF、FS、LVEDD等指标的改善差异均有统计学意义(P<0.05),CRT后对照组ΔLVEF和ΔFS较研究组增加更显著(P<0.01)。结论术前R-V_1<0.1 m V的患者CRT反应性明显优于R-V_1≥0.1 m V的患者。R-V_1振幅可作为影响CRT反应性的独立预测因素。Objective To determine the effect of V1 initial R wave amplitude （R-V1） on the response to cardiac resynchronization therapy （CRT） in patients with true left bundle branch block （t-CLBBB）. Methods From 108 patients undergoing CRT in our hospital between October 2012 and December 2016, 55 of them with t-CLBBB and complete clinical data were enrolled in the study. According to the amplitude of R-V1 before CRT, they were divided into study group （R-V1≥0.1 mV, n=26） and control group （R-V1 〈0.1 mV, n=29）. They were all followed up by a designated doctor, and regularly reviewed for echocardiography （ECG）, cardiac function （NYHA grade）, QRS duration and enddiastolic diameters left ventricle （LVEDD）, right ventricle （RVEDD）, left atrium （LAEDD）, right atrium （RAEDD）, left ventricular ejection fraction （LVEF）, and short axis shortening （FS）.The response to CRT and clinical benefits of the treatment were evaluated in the at least 6 months of follow-up, and the results were compared between the 2 groups. Results There were no significant differences in the baseline data between the 2 groups before CRT （P〉0.05）. The QRS duration, LVEF, FS and LVEDD were significantly improved after CRT （P〈0.05）, and the increases of ΔLVEF and ΔFS were more significantly in the study group than the control （P〈0.01）. Conclusion The patients with R-V1〈0.1mV before operation show better response to CRT than those with the amplitude ≥0.1 mV. PRV1 amplitude can be regarded as an independent predictive factor for CRT response.

关 键 词：V1导联起始r波振幅 真性左束支阻滞 心脏再同步化治疗 慢性充血性心力衰竭 

分 类 号：R181.23[医药卫生—流行病学] R454.1[医药卫生—公共卫生与预防医学]