室间隔肌壁间纤维化与左束支传导阻滞的相关性及对新发左束支传导阻滞的预测价值  

Correlation between ventricular septal mid-wall fibrosis and left bundle branch block and its predictive value to new-onset left bundle branch block

作　　者：刘晓洁 李慕嶂 陈佳莹 陈书芳 吴金涛[4] 张雷明[4] 李雪洁 孟令娟[4] Liu Xiaojie;Li Muzhang;Chen Jiaying;Chen Shufang;Wu Jintao;Zhang Leiming;Li Xuejie;Meng Lingjuan(Department of Cardiology,Xinyang central hospital department,Xinyang 464000,China;不详)

机构地区：[1]信阳市中心医院心内科,信阳464000 [2]河南大学人民医院(河南省人民医院),郑州450000 [3]郑州大学华中阜外医院,郑州450000 [4]河南省人民医院心脏中心(阜外华中心血管病医院)心律失常中心,郑州450000

出　　处：《中国循证心血管医学杂志》2024年第11期1335-1340,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关计划省部共建项目(SBGJ202002030)。

摘　　要：目的探讨室间隔肌壁间纤维化(SMF)与左束支传导阻滞(LBBB)的相关性,并通过分析新发LBBB的危险因素,评估室间隔肌壁间纤维化对新发LBBB的预测价值。方法回顾性分析2018年1月至2022年1月于河南省人民医院心脏中心/华中阜外医院住院诊疗的所有行心脏磁共振患者的临床资料,根据患者心电图是否存在LBBB,将患者分为LBBB组和非LBBB组。比较两组患者的临床资料,并采用单因素及多因素Logistic回归分析,评估LBBB的相关危险因素。对无LBBB组的患者进行电话随访至出现新发LBBB或2023年10月为止,并采用单因素及多因素Cox回归分析,评估新发LBBB的危险因素。结果与无LBBB患者相比,LBBB患者的年龄更大,左心房直径、左室质量及左室舒张、收缩末期内径和容积均更大,左室射血分数更低,QRS间期持续时间更长,扩张型心肌病、SMF发生率更高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄(OR=1.073;95%CI:1.049~1.097;P<0.001)、左室质量(OR=1.010,95%CI:1.004~1.016;P=0.001)、SMF(OR=2.227,95%CI:1.232~4.028;P=0.008)是LBBB存在的独立相关因素。平均随访(43.4±11.7)月,新发LBBB患者42例,Kaplan-Meier分析显示,存在SMF的患者新发LBBB的比率显著高于无SMF的患者(18.5%vs.6.9%,P<0.001)。在多因素Cox回归分析中,年龄(HR=1.042,95%CI:1.018~1.066,P<0.001)、左室质量(HR=1.012,95%CI:1.005~1.020,P=0.001)和SMF(HR=3.320,95%CI:1.768~6.232,P<0.001)是新发LBBB的独立预测因素。结论SMF与LBBB存在相关性且是新发LBBB的独立预测因素。心脏磁共振显示存在SMF的患者有较高的风险出现LBBB,需重点关注。Objective To investigate the correlation between ventricular septal mid-wall fibrosis(SMF)and left bundle branch block(LBBB),and review the predictive value of SMF to new-onset LBBB through analyzing risk factors of LBBB.Methods The clinical materials were retrospectively analyzed in patients undergone examination of cardiac magnetic resonance(CMR)in Heart Center of Henan Provincial People’s Hospital from Jan.2018 to Jan.2022.All patients were divided,according to whether there was LBBB in electrocardiogram(ECG)or not,into LBBB group and non-LBBB group.The clinical materials were compared between 2 groups.The correlative risk factors of LBBB were analyzed by using single-factor and multi-factor Logistic regression analysis.The patients in non-LBBB group were followed up by telephone until new-onset LBBB occurrence or until Oct.2023,and risk factors of new-onset LBBB were analyzed by using single-factor and multi-factor Cox regression analysis.Results Compared with non-LBBB group,in LBBB group,patients were older,the indexes of left atrial diameter(LAD),left ventricular mass(LVM),left ventricular internal dimension-diastole(LVIDd),left ventricular end-systolic diameter(LVESd),left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were higher,left ventricular ejection fraction(LVEF)was lower,QT interval was longer,and incidence rates of dilated cardiomyopathy(DCM)and SMF were higher(P<0.05).The results of multi-factor Logistic regression analysis showed that age(OR=1.073,95%CI:1.049~1.097:P<0.001),LVM(OR=1.010,95%CI:1.004~1.016:P=0.001)and SMF(OR=2.227,95%CI:1.232~4.028:P=0.008)were independent correlative factors of LBBB.The patients were followed up meanly for(43.4±11.7)months,and there were 42 patients with new-onset LBBB.The results of Kaplan-Meier analysis showed that proportion of new-onset LBBB was higher in patients with SMF than that in those without SMF(18.5%vs.6.9%,P<0.001).The results of multi-factor Cox regression analysis showed that age(HR=1.042,95%CI:1.018~1.06

关 键 词：左束支传导阻滞 室间隔肌壁间纤维化 心脏磁共振 相关性 

分 类 号：R543[医药卫生—心血管疾病]