老年无胸痛左束支传导阻滞患者的临床研究

Clinical investigation of complete left bundle branch block in older patient without chest pain

目的观察老年无胸痛左束支传导阻滞患者的病因及心功能情况。方法对79例66岁以上无胸痛的左束支传导阻滞患者常规冠状动脉造影,手术前或后1周内进行超声心动描记术检查,分析其病因及心功能情况。结果患者病因以心肌病最常见(37.9%);孤立性原因次之(22.8%);冠心病发生率仅为11.4%,但多合并较多冠心病危险因素。且显示随着QRS时间延长,所有患者的左心室舒张末径均增大,左心室射血分数下降,6min平均步行距离减少。以QRS时间≥0.16ms组最明显,两组差异均有非常显著性意义(P<0.01)。结论老年无胸痛左束支传导阻滞以心肌病最常见,合并冠心病的发生率不高,但患者的收缩舒张功能均受到损害。

Objective To assess etiology of complete left bundle branch block （LBBB） and heart function in older patient without chest pain. Methods 79 Consecutive patients with LBBB and aged more than 66 years underwent both coronary artery angiograpby and echocardiograpby within one week. Results Of all etiologies, dilated cardiomyopathy （DCM） accounted for 32.9%, coronary artery disease （CAD） 11.4%, and isolated LBBB 22.8%. Patients with CAD had more CAD risk factors. As ORS duration prolonged,left ven- tricular end diastolic diameter increased, left ventricular ejection fraction and 6-min walking distance reduced in all patients. All these changes were more significant in patients with QRS duration t〉 0.16 ms than 〈0.16ms （P〈0.05）. Conclusion The main etiology of CLBBB in older patient without chest pain was DCM. Both left ventricular systolic and diastolic functions are impaired in older patients with LBBB.