左心室收缩不同步对扩张性心肌病患者预后的预测价值

Prognostic Value of Left Ventricular Systolic Dyssynchrony in Patients With Non-Ischemic Dilated Cardiomyopathy

目的:运用组织多普勒超声心动图研究左心室收缩不同步在扩张性心肌病患者中的预后价值。方法:入选62例扩张性心肌病患者,所有患者均行心电图、超声心动图(包括组织多普勒超声心动图)及冠状动脉造影,入选患者根据心室内延迟时间(IVD)分为2组:IVD≤65 ms组(n=10),IVD>65 ms组(n=52),主要终点定义为随访期内的全因死亡。结果:IVD>65 ms组患者有较长的IVD(129±68 ms vs 58±9 ms,P<0.05),较高的左束支传导阻滞发生率(31%vs10%,P=0.05)。IVD≤65 ms组1例死亡,为心原性猝死;而IVD>65 ms组29例死亡,12例为心原性猝死,17例为进展性心力衰竭。Kaplan-Meier生存分析显示IVD>65 ms组患者有较低的生存率(P<0.05)。在调整其它主要影响因素后,IVD>65ms是死亡的独立预测因子(RR=1.8502,P<0.01)结论:高IVD是扩张性心肌病患者死亡的独立预测因素。

Objective：To investigate the prognostic value of left ventricular systolic dyssynchrony in patients with non-ischemic dilated cardiomyopathy（DCM） using tissue Doppler echocardiography. Methods：A total of 62 patients with non-ischemic DCM were studied.All patients were examined by electrocardiogram,echocardiography including tissue Doppler imaging and coronary angiography.The patients were divided into two groups according to the intra ventricular delay（IVD）,IVD≤65 ms group,n=10 and IVD 65 ms group,n=52.The mean follow-up time was（1253±177）days and the primary endpoint was the overall mortality. Results：The patients in IVD 65 ms group had significantly longer IVD than those in IVD ≤65 ms group,（129±68）ms vs.（58±9）ms,P0.05,and higher rate of left bundle branch block,31% vs.10%,P=0.05.There was 1 sudden cardiac death in IVD ≤65 ms group,and 29 death in IVD 65 ms group including 12 of sudden cardiac death and 17 of heart failure.Kaplan-Meier survival analysis showed a significant lower survival rate in IVD 65 ms group,P0.05.After adjusting the other main factors,IVD 65 ms was the independent predictor for mortality（RR=1.8502,P0.01）. Conclusion：Increased IVD is the independent predictor for mortality in patients with DCM.