60例完全性左束支传导阻滞患者的临床及冠状动脉造影特点分析

Clinical and angiographic characteristics in patients with complete left bundle branch block

目的 分析完全性左束支传导阻滞(LBBB)患者的临床以及冠状动脉和左心室造影特点。方法 60例患者为本院1993年1月～2002年7月收入院,心电图显示LBBB并接受冠状动脉造影检查。年龄35～72(51±11)岁,其中男性44例,女性16例。患者LBBB由心电图分析确定。采用Judkins法进行选择性冠状动脉及左心室造影检查,通过计算机图像处理系统测定左心室射血分数及室壁运动。所有资料采用SAS软件处理,以P<0.05作为差异有显著性。结果 在有胸痛的32例(53％)患者中,22例冠状动脉造影显示异常,10例造影正常。在28例(47％)无胸痛者中,9例冠状动脉造影异常,19例造影正常。(1)确诊为冠心病者29例(48％),其中有胸痛或心绞痛者20例,无心绞痛者9例。冠状动脉造影单支病变13例,双支病变4例,三支病变12例。左心室造影异常者18例。(2)确诊高血压病者9例(15％),其中有胸痛者4例,无胸痛者5例,冠状动脉造影均正常。(3)扩张型心肌病10例(17％),其中有胸痛者3例,无胸痛者7例,胸痛者中仅1例冠状动脉造影示前降支单支临界病变。(4)确诊风湿性心脏病2例(3％),其中1例有胸痛者冠状动脉造影显示双支病变。(5)临床仅表现LBBB,而无其他器质性心脏病证据者10例(17％);其中有胸痛者4例,无胸痛者6例,冠状动脉造影均正常。结论 LBBB较常见于冠心病。

Objective To analyses the characteristics of coronary angiography and left ventriculography in patients with complete left bundle branch block (LBBB). Methods Sixty patients with electrocardiographic findings of LBBB underwent coronary angiographic study. The age ranged from 35 to 72 years old [mean (51 ±11) years]. There were 44 men and 16 women. Selective coronary angiography and left ventriculography were performed by the Judkins technique. Statistical analysis was performed using SAS software for small samples. Results (1) Twenty-nine (48%) patients were found to have significant coronary artery disease, of which 20 complained of chest pain or angina pectoris, 9 had not chest pain. Coronary angiogram revealed that 13 patients had single vessel disease, 4 double vessels disease, 12 triple vessels disease. (2) Nine(15% ) patients had hypertension, of which 4 complained of chest pain, 5 had not chest pain. Coronary angiograms of these patients were normal. ( 3 ) Ten ( 17%) patients had cardiomyopathy, of which 3 had chest pain, 7 no chest pain. Coronary angiogram revealed LAD borderline lesion in one patient with chest pain. (4) Two(3% ) had valvular disease. Coronary angiogram revealed double-vessels disease in one patient with chest pain. (5) No etiology was discovered for the LBBB in the remaining 10 ( 17% )patients,of which 4 complained of chest pain, 6 no chest pain. All of them were with normal coronary angiogram. Conclusions LBBB occured most frequently in cardiovascular diseases, particularly in coronary artery disease. When left bundle branch block was accompanied by chest pain of uncertain etiology, or unexplained electrocardiographic abnormality, coronary angiogram was helpful to confirm ischemic heart disease and etiology.