基于心脏磁共振探讨左束支传导阻滞对扩张型心肌病患者心脏功能的影响  

Effect of Left Bundle Branch Block on Cardiac Function of Patients with Dilated Cardiomyopathy Based on Cardiac Magnetic Resonance

作　　者：李陶宇 邢军辉[1] 邢钰[1] 李凌[1] LI Tao-yu;XING Jun-hui;XING Yu;LI Ling(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,河南郑州450052

出　　处：《河南医学研究》2020年第13期2318-2321,共4页Henan Medical Research

基　　金：河南省高等学校重点科研基金资助项目(16A320049);河南省医学科技攻关计划基金资助项目(201403026)。

摘　　要：目的基于3.0 T心脏磁共振(CMR)探讨左束支传导阻滞(LBBB)对扩张型心肌病(DCM)患者心功能的影响。方法选取2018年1月至2019年2月首次于郑州大学第一附属医院心内科住院并最终诊断为DCM的139例患者,按常规12导联心电图结果分为室内传导正常组(93例)、左前分支传导阻滞(LAFB)组(17例)、完全性左束支传导阻滞(CLBBB)组(29例)。所有患者均接受心脏彩超和CMR检查,对3组患者的心脏结构、心功能[左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)、左心室心肌质量(LVM)]及核磁共振心肌延迟强化成像(LGE)进行比较。结果CLBBB组男性比例低于室内传导正常组和LAFB组,年龄大于室内传导正常组,差异有统计学意义(均P<0.0167)。各组经心脏彩超测得的LVEDV、LVESV、LVEDD及LVEF比较,差异无统计学意义(均P>0.05)。CLBBB组和LAFB组经CMR测得的LVEF均低于室内传导正常组,LGE检出率均高于室内传导正常组,CLBBB组LVESVI大于室内传导正常组,差异有统计学意义(均P<0.0167)。结论合并LBBB的DCM患者心脏功能受损更严重,心肌纤维化病变更广泛,且相对于常规心脏彩超,CMR能更好地反应LBBB对DCM患者心脏结构、心功能的影响,从而指导临床治疗。Objective To investigate the effect of left bundle branch block(LBBB)on cardiac function of patients with dilated cardiomyopathy(DCM)based on 3.0 T cardiac magnetic resonance(CMR).Methods A total of 139 patients first admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to February 2019 and finally diagnosed as DCM were selected.According to the results of routine 12-lead ECG,the patients were divided into three groups:normal ventricular conduction group(93 cases),left anterior fascicular block(LAFB)group(17 cases)and complete left bundle branch block(CLBBB)group(29 cases).CMR and echocardiography were used to compare cardiac structure,cardiac function[left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end systolic volume index(LVESVI),left ventricular end diastolic volume index(LVEDVI),left ventricular mass(LVM)]and late gadolinium enhancement(LGE)among the three groups.Results The male proportion of CLBBB group was lower than those of normal ventricular conduction group and LAFB group,and the age of CLBBB group was higher than that of normal ventricular conduction group,and the differences were statistically significant(all P<0.0167).There were no significant differences in LVEDV,LVESV,LVEDD and LVEF measured by echocardiography among the three groups(all P>0.05).The LVEF values measured by CMR in CLBBB group and LAFB group were both lower than that of normal ventricular conduction group,and the detection rates of LGE in CLBBB group and LAFB group were both higher than that in normal ventricular conduction group,and the differences were statistically significant(all P<0.0167).The LVESVI in CLBBB group was higher than that in normal ventricular conduction group,and the difference was statistically significant(P<0.0167).Conclusion DCM patients combined with LBBB have worse cardiac function and more extensive myocardial fibrosis.Compared with

关 键 词：扩张型心肌病 心脏功能 心脏磁共振 完全性左束支传导阻滞 左前分支传导阻滞 

分 类 号：R542.2[医药卫生—心血管疾病]