真性、假性完全性左束支阻滞心力衰竭患者对心脏再同步化治疗的反应性分析  

Analysis of clinical response to cardiac resynchronization therapy in patients of chronic heart failure with true or false complete left bundle branch block

作　　者：廉湘琳 秦巧云[1] Lian Xianglin;Qin Qiaoyun(Department of Cardiac Function,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心肺功能科,郑州450003

出　　处：《中国实用医刊》2019年第20期3-6,共4页Chinese Journal of Practical Medicine

基　　金：2017河南省医学科技攻关计划资助项目(201702201)。

摘　　要：目的探讨不同类型完全性左束支阻滞(CLBBB)心力衰竭患者对心脏再同步化治疗(CRT)的反应性,以获得CRT超应答预测因子.方法抽取2005年3月至2018年12月于河南省人民医院接受CRT治疗的术前心电图为CLBBB的慢性心力衰竭患者55例,并将其分为真性完全性左束支阻滞组(t-CLBBB组,27例)和假性完全性左束支阻滞组(f-CLBBB组,28例).收集两组术前一般临床资料,记录术前和术后6个月相关临床指标,评估两组CRT反应性.结果术后6个月,t-CLBBB组、f-CLBBB组患者的NYHA分级、氨基末端脑钠肽前体、左室舒张末期内径、左心房内径、左室收缩末期内径均较术前下降,且t-CLBBB组下降更明显(P<0.05);而术后两组患者的LVEF较术前上升,且t-CLBBB较f-CLBBB组上升更明显(P<0.05).t-CLBBB患者产生超应答反应的相对危险度(OR=7.913,P=0.037).结论CRT能逆转心肌重构、改善心功能.t-CLBBB是CRT超应答的预测因子.Objective To investigate the clinical response to cardiac resynchronization therapy(CRT)in chronic heart failure(CHF)patients with true or false complete left bundle branch block(CLBBB),and identify predictor of super response to CRT.Methods The data of 55 CHF patients with CLBBB received CRT in Henan Provincial People's Hospital from March 2005 to December 2018 were retrospectively studied.The patients were divided into 2 groups,true complete left bundle branch block group(t-CLBBB group,27 case)and false complete left bundle branch block group(f-CLBBB group,28 cases).The preoperative general clinical data were collected and the relevant clinical indexes were recorded before and 6 months after operation.The CRT reactivity of the two groups was evaluated.Results At 6 months after operation,NYHA classification,amino-terminal pro-brain natriuretic peptide,left ventricular end-diastolic dimension,left atrial diameter,left ventricular end-diastolic stage were significantly lower in the t-CLBBB group and f-CLBBB group,and the t-CLBBB group was more significant(P<0.05).The LVEF of the two groups increased after surgery,and the decrease in the CLBBB increased more significantly than the f-CLBBB group(P<0.05).The relative risk of a super-response response in patients with t-CLBBB group was 7.913,P=0.037.Conclusions CRT can reverse myocardial remodeling and improve the heart function.t-CLBBB is the predictive factor of super-response to CRT.

关 键 词：慢性心力衰竭 真性完全性左束支阻滞 心脏再同步化治疗 超应答 

分 类 号：R54[医药卫生—心血管疾病]