完全性左束支传导阻滞的冠心病患者中合并心功能不全的相关危险因素分析  

Analysis of Risk Factors for Cardiac Dysfunction in Patients with Coronary Heart Disease Complicated with Complete Left Bundle Branch Block

作　　者：傅文霞 乐佳玮 李若谷 FU Wenxia;LE Jiawei;LI Ruogu(Cardiac Function Room,Shanghai Chest Hospital,Shanghai Chest Hospital Shanghai Jiaotong University,Shanghai 200030,China;Department of Cardiology,Shanghai Chest Hospital,Shanghai 200030,China)

机构地区：[1]上海交通大学附属胸科医院上海市胸科医院心功能室,上海200030 [2]上海市胸科医院心内科,上海200030

出　　处：《心血管病学进展》2020年第12期1310-1314,1323,共6页Advances in Cardiovascular Diseases

摘　　要：目的探讨完全性左束支传导阻滞的冠心病患者中合并心功能不全的相关危险因素分析。方法2016年6月2020年3月因疑诊或确诊冠心病连续就诊于上海市胸科医院心内科,行选择性冠状动脉造影术及心电图诊断完全性左束支传导阻滞患者147例,最终入选冠心病(冠状动脉狭窄≥50%)且心电图诊断完全性左束支传导阻滞患者80例。根据是否发生心功能不全分成两组,同时进行单因素及多因素logistic回归分析合并心功能不全的相关因素。结果(1)2组间高血压、陈旧性心肌梗死和冠状动脉多支病变比例差异均有统计学意义(P均<0.05),且冠状动脉狭窄程度高于无心功能不全组(P=0.014);心率、脑钠肽、肌酐水平差异均有统计学意义(P均<0.05)。住院期间用药、服用β受体阻滞剂、钙通道阻滞剂、利尿剂和螺内酯比例明显高于无心功能不全组(P均<0.05)。住院期间合并心功能不全组发生主要不良心血管事件高于无心功能不全组(P=0.017)。(2)合并心功能不全组左室收缩末期内径、左室舒张末期内径、左室舒张末期容积和E/E峰比值高于无合并心功能不全组(P均<0.05)。合并心功能不全组左室短轴缩短率、左室射血分数低于无合并心功能不全组(P均<0.05)。心电图结果显示,合并心功能不全组校正的QT间期高于无合并心功能不全组(P<0.05)。(3)单因素及多因素logistic回归分析:高血压、肌酐是合并心功能不全的独立相关危险因素。结论除了常规脑钠肽升高,对于心电图提示校正的QT间期延长,具有高血压病史,肌酐升高的冠心病患者,也应该引起重视与关注。定期观察和长期随访,若出现异常升高,尽早进行就诊,防止心功能进一步恶化。Objective To investigate risk factors for cardiac dysfunction in patients with coronary heart disease(CAD)complicated with complete left bundle branch block(CLBBB).Methods 147 patients with CLBBB underwent selective coronary angiography and electrocardiogram,and consecutively hospitalized in Department of Cardiology of Shanghai Chest Hospital for suspected or diagnosed with CAD from June 2016 to March 2020 were initially selected,of whom 80 cases diagnosed with CAD(coronary artery stenosis≥50%)complicated with CLBBB were finally enrolled,and classified into non-cardiac and cardiac insufficiency group based on cardiac functions.Associated risk factors for cardiac insufficiency were analyzed by univariate and multivariate logistic regression.Results(1)There were significant differences between two groups in hypertension,prior myocardial infarction and multivessel diseases(P<0.05 each).The degree of coronary stenosis was higher in cardiac insufficiency group than non-cardiac(P=0.014).Heart rate,brain natriuretic peptide(BNP)and creatinine levels were statistically significant(P<0.05 each).Compared to non-cardiac insufficiency group,proportions of medications during hospitalization,β-blockers,calcium channel blockers,diuretics and spironolactone were increased in cardiac insufficiency group(P<0.05 each),and the major adverse cardiovascular events during hospitalization were increased as well(P=0.017).(2)The left ventricular end-systolic diameter,left ventricular end-diastolic diameter and volume,E/E peak ratio were higher in cardiac insufficiency group than non-cardiac(P<0.05 each).The FS and LVEF were lower than in cardiac insufficiency group than non-cardiac(P<0.05 each).ECG results showed that the QTC duration was higher in cardiac insufficiency group(P<0.05).(3)Univariate and multivariate logistic regression analysis showed hypertension and creatinine were independent risk factors for cardiac insufficiency in patients with CAD complicated with CLBBB.Conclusion Besides increased routine BNP,prolonged QTC durati

关 键 词：完全性左束支传导阻滞 冠心病 危险因素 心功能不全 

分 类 号：R541.4[医药卫生—心血管疾病]