QRS离散度对左束支传导阻滞患者左室收缩功能及心室非同步运动的评价

QRS dispersion in assessment of left ventricular systolic function and asynchronous left ventricular wall motion in patients with left buddle-branch block

目的探讨心电图QRS离散度(QRSD)对左束支传导阻滞(LBBB)患者左室收缩功能及心室非同步运动的评价情况。方法 42例心内科住院时发现的伴有LBBB的患者,按病因分为孤立性LBBB组(7例)和合并器质性疾病的LBBB组(35例),另选择28例正常人作为对照组。对比分析三组间超声心动图及心电图数据,包括左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、E/A比值、室间机械延迟时间(IVMD)、左心室收缩不同步指数(TS-SD)、QRSD、QRS间期(QRSd);LBBB两组QRSD、QRSd分别与超声心动图相关指标做多元相关性分析。结果 LBBB组与对照组比较,除孤立性LBBB组LVEDD外(P=0.145),其余指标差异均有统计学意义(P<0.05);LBBB两组之间比较,除QRSd外(P=0.175),其余指标差异亦有统计学意义(P<0.05);LBBB两组QRSd与QRSD均与LVEF呈负相关,其中QRSd的相关系数为-0.310(P=0.046),QRSD的相关系数为-0.341(P=0.027);QRSD与TS-SD呈正相关,其相关系数为0.318(P=0.040),其余指标相关性不强。结论心电图QRS离散度对评价LBBB患者左室收缩功能损害方面有参考价值,对评价心室非同步运动方面作用有待于进一步研究确定。

Objective To evaluate the role of QRS dispersion（QRSD） in evaluating left ventricular function and the asynchrony of ventricular motion in patients with left buddle-branch block（LBBB）.Methods Forty-two hospitalized patients with LBBB and 28 normal controls （group C） were included in the present study.The 42 LBBB patients were further divided into 2 groups：the isolated LBBB patients （group A,n=7） and LBBB patients with other organic diseases （group B,n=35）.The indices of echocardiography and electrocardiogram were compared and analyzed among the three groups,including left ventricular ejection（LVEF）,left ventricular end-diastolid dimension（LVEDD）,E/A ratio,interventricular mechanical delay（IVMD）,left ventricular systolic asynchrony index （TS-SD）,QRSD,and QRS duration（QRSd）.Multivariate correlation analysis was used to analyze the correlation of QRSD and QRSd with the indices of electrocardiogram and echocardiography in the two LBBB groups.Results All the indices were significantly different between group B and group C （P〈0.05）,except for LVEDD in group A （P=0.145）.All the indices were significantly different between group A and group B,except for QRSd （P=0.175）.The QRSd and QRSD were negatively correlated with LVEF in the two LBBB groups,with the correlation coefficients being-0.310 （P=0.046） for QRSd and-0.341 （P=0.027） for QRSD; QRSD and TS-SD were positively correlated,with the correlation coefficient being 0.318 （P=0.040）.The rest indices were not significantly correlated.Conclusion QRSD of ECG can be used for evaluating left ventricular systolic dysfunction in patients with LBBB.However,further studies are needed in order to determine its role in estimating the asynchrony of ventricular motion.