天津医药
天津醫藥
천진의약
TIANJIN MEDICAL JOURNAL
2015年
4期
432-435
,共4页
林艳玉%吴冬燕%许静%陈炳伟
林豔玉%吳鼕燕%許靜%陳炳偉
림염옥%오동연%허정%진병위
心力衰竭%束支传导阻滞%心室功能,左%心脏再同步化治疗%左束支传导阻滞
心力衰竭%束支傳導阻滯%心室功能,左%心髒再同步化治療%左束支傳導阻滯
심력쇠갈%속지전도조체%심실공능,좌%심장재동보화치료%좌속지전도조체
heart failure%bundle-branch block%ventricular function,left%cardiac resynchronization therapy%left bundle branch block
目的：分析不同形态左束支传导阻滞（LBBB）的慢性充血性心力衰竭患者从心脏再同步化治疗（CRT）中获益是否相同。方法选取植入CRT装置且合并LBBB的42例慢性充血性心力衰竭患者。根据植入术前体表心电图形态分为“真性”LBBB组32例：V1、V2导联负向波为主（QS或rS），V1、V2、V5、V6、I、aVL导联中至少有2个以上的导联QRS波中间有切迹或顿挫，QRS时限男≥140 ms、女≥130 ms；“假性”LBBB组10例：符合传统的LBBB标准，但尚未达到“真性”LBBB诊断标准。随访1年，比较2组患者QRS波时限（ms）、超声测量指标及纽约心功能分级（NYHA分级）变化。以NYHA分级降低≥1级和（或）左室收缩末容积（LVESV）减少≥15%定义为对CRT有效，以LVESV减少≥30%定义为超反应。结果2组患者基础临床指标差异无统计学意义。随访1年后真性组和假性组对CRT治疗有效患者分别为20例和6例，差异无统计学意义（P>0.05）；对CRT有效的患者中，真性组的左室射血分数（LVEF）及左心室舒张末期内径（LVEDD）较假性组改善更加明显（P<0.05）。结论新LBBB诊断标准不能预测CRT的治疗效果，但符合新标准的CRT有效患者可能从CRT治疗中获益程度更大。
目的：分析不同形態左束支傳導阻滯（LBBB）的慢性充血性心力衰竭患者從心髒再同步化治療（CRT）中穫益是否相同。方法選取植入CRT裝置且閤併LBBB的42例慢性充血性心力衰竭患者。根據植入術前體錶心電圖形態分為“真性”LBBB組32例：V1、V2導聯負嚮波為主（QS或rS），V1、V2、V5、V6、I、aVL導聯中至少有2箇以上的導聯QRS波中間有切跡或頓挫，QRS時限男≥140 ms、女≥130 ms；“假性”LBBB組10例：符閤傳統的LBBB標準，但尚未達到“真性”LBBB診斷標準。隨訪1年，比較2組患者QRS波時限（ms）、超聲測量指標及紐約心功能分級（NYHA分級）變化。以NYHA分級降低≥1級和（或）左室收縮末容積（LVESV）減少≥15%定義為對CRT有效，以LVESV減少≥30%定義為超反應。結果2組患者基礎臨床指標差異無統計學意義。隨訪1年後真性組和假性組對CRT治療有效患者分彆為20例和6例，差異無統計學意義（P>0.05）；對CRT有效的患者中，真性組的左室射血分數（LVEF）及左心室舒張末期內徑（LVEDD）較假性組改善更加明顯（P<0.05）。結論新LBBB診斷標準不能預測CRT的治療效果，但符閤新標準的CRT有效患者可能從CRT治療中穫益程度更大。
목적：분석불동형태좌속지전도조체（LBBB）적만성충혈성심력쇠갈환자종심장재동보화치료（CRT）중획익시부상동。방법선취식입CRT장치차합병LBBB적42례만성충혈성심력쇠갈환자。근거식입술전체표심전도형태분위“진성”LBBB조32례：V1、V2도련부향파위주（QS혹rS），V1、V2、V5、V6、I、aVL도련중지소유2개이상적도련QRS파중간유절적혹돈좌，QRS시한남≥140 ms、녀≥130 ms；“가성”LBBB조10례：부합전통적LBBB표준，단상미체도“진성”LBBB진단표준。수방1년，비교2조환자QRS파시한（ms）、초성측량지표급뉴약심공능분급（NYHA분급）변화。이NYHA분급강저≥1급화（혹）좌실수축말용적（LVESV）감소≥15%정의위대CRT유효，이LVESV감소≥30%정의위초반응。결과2조환자기출림상지표차이무통계학의의。수방1년후진성조화가성조대CRT치료유효환자분별위20례화6례，차이무통계학의의（P>0.05）；대CRT유효적환자중，진성조적좌실사혈분수（LVEF）급좌심실서장말기내경（LVEDD）교가성조개선경가명현（P<0.05）。결론신LBBB진단표준불능예측CRT적치료효과，단부합신표준적CRT유효환자가능종CRT치료중획익정도경대。
Objective To compare the efficacy of cardiac resynchronization therapy (CRT) on chronic heart failure (CHF) patients with different left bundle branch block (LBBB) morphologies. Methods Patients(n=45)who were treated with CRT were enrolled. According to the intrinsic ECG morphologies, patients were divided into 1)"genuine"LBBB group (n=32) who present negative dominant V1 and V2 lead wave (QS or rS);mid-QRS notching or slurring in at least 2 leads of Vl, V2, V5, V6, I and aVL as well as QRS duration≥140 ms in male or≥130 ms in female and 2)"false"LBBB group (n=10) who meet traditional standards but fail to meet“genuine”LBBB diagnostic standard. The QRS duration, echocardiographic indi?ces and New York Heart Association (NYHA) Functional Classification were evaluated at the 12 months follow-up. CRT re?sponder was defined as patient with≥1 decrease in NYHA class and/or with≥15%reduction in left ventricular end-systolic volume (LVESV). CRT super-responder was defined as patient with≥30%reduction in LVESV. Results There was no dif?ference in basic characteristics of patients between groups. At the 12 months follow-up, 20 patients in "genuine" LBBB group and 6 patients in"false"LBBB group were identified as responders (P>0.05). Compared with those in"false"LBBB group, the responders in"genuine"LBBB group showed better improvement in left ventricular ejection fraction and left ven?tricular end diastolic diameter (LVEDD) (both P<0.05). Conclusion Left bundle branch block morphology is less predic?tive for the efficacy of CRT. However, patients who show response to CRT with"genuine"LBBB profile may get more bene?fits from CRT treatment than the patients with"false"LBBB profile.
