真假性左束支阻滞对心脏再同步化治疗预后影响的荟萃分析  

Meta-analysis of the effect of true and false left bundle branch block on the prognosis of cardiac resynchronization therapy

作　　者：程超頔 彭信怡 石亮[1,2] 王彦江 黄丽洪[1,2] 田颖 刘兴鹏 CHENG Chaodi;PENG Xinyi;SHI Liang;WANG Yanjiang;HUANG Lihong;TIAN Ying;LIU Xingpeng(The Third Clinical Medical School,Capital Medical University,Beijing 100009;Heart Center,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学第三临床医学院,北京100009 [2]首都医科大学附属北京朝阳医院心脏中心,北京100020

出　　处：《实用心电学杂志》2021年第3期176-184,共9页Journal of Practical Electrocardiology

基　　金：北京市自然科学基金资助项目(7202050)。

摘　　要：目的比较真性左束支阻滞(left bundle branch block,LBBB)患者及假性LBBB患者对心脏再同步化治疗(cardiac resynchronization therapy,CRT)反应性的差异。方法检索中英文数据库,根据制定的纳入及排除标准筛选并确定最终纳入分析的研究,提取临床表现、心脏超声结果、治疗方式及临床结局等相关研究内容,进行数据统计及荟萃分析。结果最终共纳入10篇文献,荟萃分析结果显示,真性LBBB患者接受CRT后,其左室射血分数(SMD0.89,95%CI 0.64~1.14,P=0.000)、左室舒张末内径(SMD-0.78,95%CI-1.35~-0.21,P=0.008)、QRS波时限(SMD-0.91,95%CI-1.16~-0.66,P=0.000)等指标均具有更佳的反应性。结论鉴别真假性LBBB有助于预测CRT的预后,从而筛选更适合CRT的人群,对临床决策具有较强的指导意义。Objective To compare the difference in the response to cardiac resynchronization therapy(CRT) between patients with true left bundle branch block(LBBB)and false LBBB.Methods Both Chinese and English databases were searched,and all the included literature was screened and identified according to the established inclusion and exclusion criteria.Relevant data including clinical manifestations,echocardiography results,treatment,and clinical outcomes were extracted for data statistics and meta-analysis.Results Ten studies are ultimately involved.Meta-analysis results show that true LBBB patients have better CRT response in the indexes including left ventricular ejection fraction(SMD 0.89,95%CI 0.64 to 1.14,P=0.000),left ventricular end diastolic dimension(SMD-0.78,95%CI-1.35 to-0.21,P=0.008),and QRS duration(SMD-0.91,95%CI-1.16 to-0.66,P=0.000).Conclusion Differentiation between true and false LBBB helps to predict the prognosis of CRT,and select more appropriate population for CRT.It is instructively significant for clinical decision making.

关 键 词：心力衰竭 左束支阻滞 心脏再同步化治疗 Strauss定义 真性左束支阻滞 反应性 

分 类 号：R541.7[医药卫生—心血管疾病]