天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (4): 432-435.doi: 10.11958/j.issn.0253-9896.2015.04.027

• 应用研究 • 上一篇    下一篇

不同左束支阻滞形态的心力衰竭患者心脏再同步治疗效果比较

林艳玉1，吴冬燕2，许静2△，陈炳伟2   

  1. 1天津医科大学研究生院（邮编300070）；2天津市胸科医院心内科
  • 收稿日期:2014-09-10 修回日期:2015-02-06 出版日期:2015-04-15 发布日期:2015-04-13
  • 通讯作者: 许静 E-mail:linyan_yu88@126.com
  • 作者简介:林艳玉(1988)，女，硕士在读，主要从事心律失常方面研究

Effect of cardiac resynchronization therapy on heart failure patients with different morphologies of left bundle branch block in ECG

LIN Yanyu1, WU Dongyan2, XU Jing2△, CHEN Bingwei2   

  1. 1 Tianjin Medical University, Tianjin 300070, China; 2 Tianjin Chest Hospital
  • Received:2014-09-10 Revised:2015-02-06 Published:2015-04-15 Online:2015-04-13
  • Contact: XU Jing E-mail:linyan_yu88@126.com

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摘要： 摘要：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。

关键词: 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

Abstract: Abstract: 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.

Key words: heart failure, bundle- branch block, ventricular function, left, cardiac resynchronization therapy, left bundle branch block