QRS波增宽的缺血性心肌病患者PCI术后QRS波时限及心功能变化的随访研究  

The changes of cardiac function and QRS duration in ischemic cardiomyopathy patients with prolonged QRS after PCI

作　　者：于万德 程培培 高晓飞[1] 任晓敏[1] 朱琳琳[1] YU Wande;CHENG Peipei;GAO Xiaofei;REN Xiaomin;ZHU Linlin(Departmant of Cardiology,Nanjing First Hospital,Nanjing Medical University,Jiangsu210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心内科

出　　处：《国际心血管病杂志》2019年第5期305-308,共4页International Journal of Cardiovascular Disease

基　　金：南京市医学科技发展一般性课题(YKK16127)

摘　　要：目的:探讨QRS波增宽的缺血性心肌病患者经皮冠状动脉介入术(PCI)后QRS波时限(QRSd)及心功能的变化。方法:选取2017年1月1日至12月31日在南京市第一医院心内科诊断为QRS波增宽(QRSd≥120 ms)伴收缩性心功能不全且接受PCI治疗的缺血性心肌病患者63例。术后随访1年,观察患者手术前后QRSd、左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)、纽约心脏病协会(NYHA)心功能分级的变化,以及PCI术后心力衰竭再住院率。结果:PCI术后患者的LVEF、NT-proBNP及心功能分级显著改善。QRS波形态为非特异性室内传导阻滞(IVCD)的患者PCI术后QRSd明显缩短;而完全性左束支传导阻滞(CLBBB)及完全性右束支传导阻滞(CRBBB)两个亚组的患者手术前后QRSd无明显差异。IVCD亚组患者PCI术后LVEF、NT-proBNP及心功能分级明显改善,而CLBBB及CRBBB亚组患者PCI术后上述指标无明显改变。PCI术后IVCD亚组患者心力衰竭再住院率较CLBBB及CRBBB亚组显著降低。结论:PCI可以改善QRS波增宽的缺血性心肌病患者的心功能,获益主要来源于术后QRSd缩短的IVCD亚组患者。PCI术后QRSd缩短可作为此类患者术后心功能改善的预测指标。Objective:To explore the changes of QRS duration and cardiac function in ischemic cardiomyopathy patients with prolonged QRS after percutaneous coronary intervention(PCI).Methods:Sixty-three ischemic cardiomyopathy patients with prolonged QRS(QRS duration≥120 ms)and systolic dysfunction,who underwent PCI in Nanjing First Hospital from January 1,2017 to December 31,2017 were enrolled.QRS durationd,left ventricular ejection fraction(LVEF),N-terminal pro-B-type natriuretic peptide(NT-proBNP),NYHA functional classification and rehospitalization due to heart failure were recorded during the one year follow-up.Results:PCI significantly improved LVEF,NT-proBNP and NYHA class.QRS duration was markedly shortened after PCI in the subgroup of non-specific intraventricular conduction delay(IVCD).However,both in subgroups of complete left bundle branch block(CLBBB)and complete right bundle branch block(CRBBB),there were no significant statistic difference in QRS duration before and after PCI.LVEF,NT-proBNP and NYHA class were obviously improved after PCI in IVCD subgroup,which neither in CLBBB group nor in CRBBB group was observed.Rehospitalization due to heart failure in IVCD subgroup apparently decreased compared with that in CLBBB subgroup and CRBBB subgroup after PCI.Conclusions:PCI could significantly improve cardiac function in ischemic cardiomyopathy patients with prolonged QRS duration,which is mainly driven by the IVCD subgroup(QRS duration shortens after PCI).Shortened QRS duration after PCI could be a predictor of improvement in cardiac function.

关 键 词：经皮冠状动脉介入术 QRS波时限 收缩性心功能不全 缺血性心肌病 

分 类 号：R54[医药卫生—心血管疾病]