左束支阻滞性心肌病的临床特征  

Clinical characteristics of left bundle branch block-induced cardiomyopathy

作　　者：俞娅娅 陶琴 许定虎 原晖华 张郁青 Yu Yaya;Tao Qin;Xu Dinghu;Yuan Huihua;Zhang Yuqing(Department of Cardiology,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,Jiangsu,China;Department of Radiology,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,Jiangsu,China)

机构地区：[1]南京医科大学附属江宁医院心内科,江苏南京211100 [2]南京医科大学附属江宁医院影像科,江苏南京211100

出　　处：《中国心脏起搏与心电生理杂志》2024年第5期329-333,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：南京医科大学科技发展基金(NMUB20210146)。

摘　　要：目的 探究左束支阻滞性心肌病临床特点,为临床诊断和治疗提供依据。方法 对我院2020年1月至2024年3月诊治的左束支阻滞性心肌病患者的临床资料进行回顾性分析,总结其临床表现、影像学特征、治疗及随访结果。结果 共6例患者符合左束支阻滞性心肌病的诊断,平均年龄(68.33±6.80)岁。从发现完全性左束支阻滞至出现心力衰竭症状平均病程为2.52年,最短病程为4个月,最长病程为7年。患者超声心动图均表现为左室扩大,以及左室射血分数减低;心脏核磁共振检查可见左室收缩期室间隔增厚幅度较侧壁增厚幅度小。6例患者中4例经指南指导的药物治疗,除1例外3例患者心功能无明显改善;另外2例患者给予起搏治疗,随访显示心功能均明显好转。结论 左束支阻滞性心肌发病年龄偏大,心脏核磁共振有其特征性表现,药物优化治疗效果通常不佳,建议积极通过起搏纠正左束支传导阻滞,改善患者预后。Objective To explore the clinical characteristics of left bundle branch block-induced cardiomyopathy,and offer significant insight for clinical diagnosis and treatment.Methods The clinical data of patients with left bundle branch block-induced cardiomyopathy between January 2020 and March 2024 were retrospectively analyzed,and their clinical characteristics,imaging features,treatment and follow-up results were summarized.Results A total of 6 patients were enrolled.The mean age of them was(68.33±6.80)years.The mean duration from the dis-covery of complete left bundle branch block to the onset of heart failure was 2.52 years,with the shortest duration being 4 months and the longest duration being 7 years.Left ventricular enlargement and decreased ejection fraction were found on echocardiography in all 6 patients.Cardiac MRI showed left ventricular septal thickening during sys-tole was less than lateral wall thickening.Of the 6 cases,4 were treated with guideline-directed medical therapy,of which 3 patients had no significant improvement in cardiac function,and 1 patient showed improvement.The other 2 patients were given pacing,and the follow-up showed significant improvement in cardiac function.Conclusion Left bundle branch block-induced cardiomyopathy develops at a much older age and has a characteristic cardiac MRI presentation.Patients with left bundle branch block-induced cardiomyopathy usually do not respond well to drugs.Therefore,our findings suggests correcting left bundle branch block with pacing to improve the patient's prognosis.

关 键 词：心血管病学 电生理学 左束支传导阻滞 心肌病 心力衰竭 心脏起搏器 

分 类 号：R542.2[医药卫生—心血管疾病] R318.11[医药卫生—内科学] R331.38[医药卫生—临床医学]