经组织多普勒筛选的右束支传导阻滞心力衰竭患者行心脏再同步化治疗的疗效

Effects of cardiac resynchronization therapy in heart failure patients with right bundle branch block after assessment by tissue doppler imaging

目的观察经组织多普勒(TDI)筛选的右束支传导阻滞(RBBB)的心力衰竭患者行心脏再同步化治疗(CRT)的效果。方法 8例心力衰竭合并RBBB患者接受了CRT,其中5例并发左侧束支的部分阻滞(LHB),3例为单纯RBBB,所有患者符合CRT治疗的I类适应证,并在CRT治疗前应用TDI进行了严格筛选,所有患者均存在心室间及室内收缩不协调,左室电极尽量放置在收缩最延迟处,观察患者术后症状及超声指标改善情况。结果 CRT术后6个月随访,所有患者均存活,其中5例并发LHB患者及1例单纯RBBB患者NYHA心功能分级改善至少1级,射血分数改善大于5%,其余2例单纯RBBB患者对CRT治疗无反应,NYHA心功能分级未改善,射血分数改善小于5%。结论经TDI筛选的RBBB心力衰竭患者可从CRT治疗中获益,但获益的患者多数合并有LHB,而只有较少单纯RBBB患者从CRT获益。

Objective To evaluate the effects of cardiac resynchronization therapy （CRT） in heart failure （HF） patients with right bundle branch block （RBBB） after assessment by tissue doppler imaging （TDI）. Methods Eight patients with standard CRT indications who underwent implantation of CRT at our institution were included, of whom 5 patients had RBBB plus left fascicular hemiblock （ RBBB-LFH）, 3 patients had pure RBBB. Standard echocardiography and TDI were performed before CRT, and interventricular and intraventricular dyssynchrony were quantified by TDI examination. Symptomatic response and echocardiographic response were evaluated in 6 month of follow-up. Results Eight patients all survived at 6 months of follow-up. Six patients, of whom 5 patients with RBBB-LFH and 1 patient with pure RBBB, demonstrated improvement in ejection fraction（EF） of at least 5% , and an improvement in New York Heart Association（NYHA） HF class at 6 months of follow-up. There were no change in the other 2 non-responder patients with pure RBBB. Conclusion Patients with RBBB and significant intraventricular mechanical delay may benefit from CRT. Most patients with RBBB benefiting from CRT have a coexisting LHB, but patients with pure RBBB rarely benefiting from CRT.