左束支区域起搏对慢性收缩性心力衰竭患者左心室收缩同步性、预后的影响  

Influence of left bundle branch area pacing on left ventricular systolic synchronization and prognosis in patients with chronic systolic heart failure

作　　者：汪敏 钱钧 WANG Min;QIAN Jun(Department of Cardiology,Maanshan General Hospital of Ranger-Duree Healthcare,Maanshan,Anhui,243000,China)

机构地区：[1]德驭医疗马鞍山总医院心血管内科,安徽马鞍山243000

出　　处：《心血管康复医学杂志》2024年第6期771-775,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：2019年度马鞍山市卫生健康委科研项目(YL-2019-14)。

摘　　要：目的:探究左束支区域起搏(LBBAP)对慢性收缩性心力衰竭患者左心室收缩同步性、预后的影响。方法:根据不同起搏方式将德驭医疗马鞍山总医院2020年6月~2021年12月收治的110例慢性收缩性心力衰竭患者分为LBBAP组(60例)与右心室起搏(RVP)组(50例)。对比两组手术前、3个月后起搏参数、心功能、左室收缩同步性等相关指标及6个月后的预后情况。结果:术后3个月,与RVP组比较,LBBAP组起搏阻抗[(560.34±61.32)Ω比(507.20±44.29)Ω]、QRS时限[(132.57±22.91)ms比(123.61±20.55)ms]以及左心室收缩同步性参数中峰值应变离散度(PSD)[(58.24±10.57)ms比(45.30±6.20)ms]、纵向收缩应变达峰时间差(Tls-Dif)[(238.57±50.13)ms比(152.42±40.15)ms]、横向收缩同步性标准差(Trs-SD)[(122.35±9.14)ms比(78.18±5.46)ms]、前间隔-左心室后壁收缩期径向应变达峰时间差(Tas-post)[(138.19±20.36)ms比(69.14±20.45)ms]均显著减少,左室射血分数(LVEF)[(46.62±5.80)%比(50.54±5.68)%]显著提高(P<0.05或<0.01)。LBBAP组术后6个月心脏再同步化治疗(CRT)有反应比例显著高于RVP组(88.33%比72.00%,P=0.030),两组心衰再入院率、全因死亡率对比均无明显差异(P均>0.05)。结论:LBBAP能有效改善慢性收缩性心力衰竭患者心功能,保证左心室收缩的同步性,CRT有反应率高,预后较好。Objective:This study aims to investigate the influence of left bundle branch area pacing(LBBAP)on left ventricular systolic synchronization and prognosis in patients with chronic systolic heart failure.Methods:According to different pacing methods,a total of 110 patients with chronic systolic heart failure admitted in Maanshan General Hospital of Ranger-Duree Healthcare between June 2020 and December 2021 were divided into LBBAP group(n=60)and right ventricular pacing(RVP)group(n=50).Pacing parameters,cardiac function,left ventricular systolic synchronization related indexes before and 3 months after operation,and prognosis after 6 months were compared between two groups.Results:Compared with patients in RVP group 3 months after operation,those in LBBAP group had significant lower pacing impedance[(560.34±61.32)Ωvs.(507.20±44.29)Ω],QRS duration[(132.57±22.91)ms vs.(123.61±20.55)ms],peak strain dispersion(PSD)[(58.24±10.57)ms vs.(45.30±6.20)ms],time to longitudinal systolic strain difference(Tls-Dif)[(238.57±50.13)ms vs.(152.42±40.15)ms],transverse systolic strain difference(Trs-SD)[(122.35±9.14)ms vs.(78.18±5.46)ms]and time to aortic systolic strain posterior(Tas-post)[(138.19±20.36)ms vs.(69.14±20.45)ms],and significant higher left ventricular ejection fraction(LVEF)[(46.62±5.80)%vs.(50.54±5.68)%](P<0.05 or<0.01).Proportion of positive response to cardiac resynchronization therapy(CRT)after 6 months in LBBAP group was significantly higher than that of RVP group(88.33%vs.72.00%,P=0.030).There were no significant difference in heart failure-caused rehospitalization rate and all-cause mortality between two groups(P>0.05 both).Conclusion:LBBAP could effectively improve cardiac function,ensure the synchronization of left ventricular contraction,with high CRT response rate and good prognosis in patients with chronic systolic heart failure.

关 键 词：心力衰竭 收缩性 心脏起搏 人工 心脏再同步疗法 

分 类 号：R541.61[医药卫生—心血管疾病]